Healthcare Provider Details

I. General information

NPI: 1871787382
Provider Name (Legal Business Name): BECTON ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12909 56TH ST STE 204
TEMPLE TERRACE FL
33617
US

IV. Provider business mailing address

12909 56TH ST N STE 204
TEMPLE TERRACE FL
33617
US

V. Phone/Fax

Practice location:
  • Phone: 813-929-7067
  • Fax: 813-985-1255
Mailing address:
  • Phone: 813-929-7067
  • Fax: 813-985-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number30211314
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number30211314
License Number StateFL

VIII. Authorized Official

Name: MRS. CHRISTAL RENEE' BECTON
Title or Position: DIRECTOR
Credential: MA.
Phone: 813-929-7067