Provider Demographics
NPI:1861954661
Name:LA BELLA VITA, LLC
Entity type:Organization
Organization Name:LA BELLA VITA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:573-864-0089
Mailing Address - Street 1:2814 BURRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2908
Mailing Address - Country:US
Mailing Address - Phone:573-864-0089
Mailing Address - Fax:
Practice Address - Street 1:2814 BURRWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2908
Practice Address - Country:US
Practice Address - Phone:573-864-0089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities