Healthcare Provider Details

I. General information

NPI: 1346892742
Provider Name (Legal Business Name): BEULAH NURSING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SUGAR MAPLE CT
WALDORF MD
20602-2625
US

IV. Provider business mailing address

3500 SUGAR MAPLE CT
WALDORF MD
20602-2625
US

V. Phone/Fax

Practice location:
  • Phone: 301-395-7874
  • Fax:
Mailing address:
  • Phone: 301-395-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ADEBISI SHOWUNMI
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-395-7874