Provider Demographics
NPI:1245691625
Name:BELLA VITA HEALTHCARE
Entity type:Organization
Organization Name:BELLA VITA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PURINTON
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:928-300-5360
Mailing Address - Street 1:203 S CANDY LN
Mailing Address - Street 2:SUITE 6AB
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4120
Mailing Address - Country:US
Mailing Address - Phone:928-634-0391
Mailing Address - Fax:928-634-6145
Practice Address - Street 1:203 S CANDY LN
Practice Address - Street 2:SUITE 6AB
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4120
Practice Address - Country:US
Practice Address - Phone:928-634-0391
Practice Address - Fax:928-634-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3450363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ496545Medicaid