Healthcare Provider Details

I. General information

NPI: 1760732788
Provider Name (Legal Business Name): BEACHERSEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 COUNTY ROAD 234
DURANGO CO
81301-8206
US

IV. Provider business mailing address

2302 COUNTY ROAD 234
DURANGO CO
81301-8206
US

V. Phone/Fax

Practice location:
  • Phone: 970-426-9226
  • Fax:
Mailing address:
  • Phone: 970-426-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1438
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY BEACH PETERSEN
Title or Position: OWNER/OPERATOR
Credential:
Phone: 970-426-9226