Healthcare Provider Details

I. General information

NPI: 1467162461
Provider Name (Legal Business Name): BEACHSIDE IN HOME SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MARKET ST STE 1A
SMITHFIELD NC
27577-3979
US

IV. Provider business mailing address

101 E MARKET ST STE 1A
SMITHFIELD NC
27577-3979
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-8112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: AMY ARTIS
Title or Position: PRESIDENT
Credential:
Phone: 919-938-8112