Provider Demographics
NPI:1174384622
Name:BEAUTIFUL BODY AND SOUL LLC
Entity type:Organization
Organization Name:BEAUTIFUL BODY AND SOUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, APRN
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:217-494-5802
Mailing Address - Street 1:2103 1200TH ST
Mailing Address - Street 2:
Mailing Address - City:BEASON
Mailing Address - State:IL
Mailing Address - Zip Code:62512-9746
Mailing Address - Country:US
Mailing Address - Phone:217-494-5802
Mailing Address - Fax:
Practice Address - Street 1:2103 1200TH ST
Practice Address - Street 2:
Practice Address - City:BEASON
Practice Address - State:IL
Practice Address - Zip Code:62512-9746
Practice Address - Country:US
Practice Address - Phone:217-494-5802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care