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General NPI Number Information
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NPI Number | 1134126741
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Entity Type | Organization
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Legal Business Name | BEAUMONT HOME HEALTH SERVICE, INC
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Dates
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Enumeration Date | 06/29/2005
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 1725 WEST CARDINAL DRIVE
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City | BEAUMONT
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State | TX
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Zip | 77705-6415
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Country | US
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Telephone | 409-833-4632
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Fax | 409-833-2774
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Provider Business Mailing Address
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Address Line | 3202 SAM HOUSTON DR
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City | VICTORIA
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State | TX
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Zip | 77904-2240
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Country | US
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Telephone | 361-578-0762
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Fax | 361-578-1567
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | DR. RUTH LAVERNE CONSTANT
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Credential | RN, MSN, EDD
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Telephone | 361-578-0762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 003147
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License Number State | TX
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