Healthcare Provider Details

I. General information

NPI: 1720752181
Provider Name (Legal Business Name): BEULAH HEALTH CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 N FARRELL CT STE 109
GILBERT AZ
85233-1945
US

IV. Provider business mailing address

1324 N FARRELL CT STE 109
GILBERT AZ
85233-1945
US

V. Phone/Fax

Practice location:
  • Phone: 623-201-0084
  • Fax: 623-444-9566
Mailing address:
  • Phone: 623-201-0084
  • Fax: 623-444-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE O SAMUEL-OJO
Title or Position: NURSE PRACTITIONER
Credential: DNP
Phone: 623-201-0084