Healthcare Provider Details

I. General information

NPI: 1619823044
Provider Name (Legal Business Name): BEULAH'S HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18521 DEPOT RD
MC KENNEY VA
23872-2909
US

IV. Provider business mailing address

18521 DEPOT RD
MC KENNEY VA
23872-2909
US

V. Phone/Fax

Practice location:
  • Phone: 804-496-3193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY CHARMAINE JONES
Title or Position: PROGRAM MANAGER
Credential:
Phone: 804-496-3193