Healthcare Provider Details

I. General information

NPI: 1235967332
Provider Name (Legal Business Name): BEYAH CARES FOR YOU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 S 42ND ST
PHOENIX AZ
85040-9029
US

IV. Provider business mailing address

5625 S 42ND ST
PHOENIX AZ
85040-9029
US

V. Phone/Fax

Practice location:
  • Phone: 602-418-9185
  • Fax:
Mailing address:
  • Phone: 602-418-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MONETTE JACKSON
Title or Position: EMPLOYEE
Credential: REGISTERED NURSE
Phone: 602-418-9185