Healthcare Provider Details

I. General information

NPI: 1861750648
Provider Name (Legal Business Name): BEULAH HOME SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 CAITLIN COURT
SILVER SPRING MD
20904
US

IV. Provider business mailing address

1407 CAITLIN COURT
SILVER SPRINGS MD
20904
US

V. Phone/Fax

Practice location:
  • Phone: 301-502-6011
  • Fax:
Mailing address:
  • Phone: 301-502-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberR3186P
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberR3186P
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR3186P
License Number StateMD

VIII. Authorized Official

Name: MRS. PATIENCE AKPOTIRIH ERHIAWARIEN
Title or Position: ADMINISTRATOR
Credential: MHA
Phone: 301-502-6011