Provider Demographics
NPI:1053712018
Name:BELLA VIDA MASSAGE & BODYWORK, LLC
Entity type:Organization
Organization Name:BELLA VIDA MASSAGE & BODYWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-396-9617
Mailing Address - Street 1:239 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2003
Mailing Address - Country:US
Mailing Address - Phone:503-396-9617
Mailing Address - Fax:
Practice Address - Street 1:239 S 1ST ST
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2003
Practice Address - Country:US
Practice Address - Phone:503-396-9617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14160261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR14160OtherSTATE LICENSE
1134358112OtherNPI NUMBER TYPE 1