Healthcare Provider Details

I. General information

NPI: 1114794831
Provider Name (Legal Business Name): BEULAH INTEGRATED HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W SAINT CATHERINE AVE
PHOENIX AZ
85041-5917
US

IV. Provider business mailing address

1205 W SAINT CATHERINE AVE
PHOENIX AZ
85041-5917
US

V. Phone/Fax

Practice location:
  • Phone: 602-598-9321
  • Fax:
Mailing address:
  • Phone: 602-598-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NEEKPOA BARINUA LAWRENCE JR.
Title or Position: OWNER / MANAGER
Credential: ETC.
Phone: 602-598-9321