Healthcare Provider Details

I. General information

NPI: 1669309084
Provider Name (Legal Business Name): BEAUVAIS HEALTH HOMECARE 3 BEAUVAIS NURSING SCHOOL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NORTHFIELD AVE STE 208A
WEST ORANGE NJ
07052-4730
US

IV. Provider business mailing address

111 NORTHFIELD AVE STE 208A
WEST ORANGE NJ
07052-4730
US

V. Phone/Fax

Practice location:
  • Phone: 973-486-4412
  • Fax: 973-537-1006
Mailing address:
  • Phone: 973-486-4412
  • Fax: 973-537-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. WILDA B BEAUVAIS
Title or Position: OWNER
Credential: DO
Phone: 954-997-5842