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General NPI Number Information
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NPI Number | 1144104142
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Entity Type | Organization
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Legal Business Name | BEAUFORT ENTERPRISES LLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 3023 E COPPER POINT DR STE 207
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City | MERIDIAN
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State | ID
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Zip | 83642-9290
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Country | US
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Telephone | 208-357-4595
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Fax |
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Provider Business Mailing Address
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Address Line | 1362 E NEST VIEW CT
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City | EAGLE
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State | ID
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Zip | 83616-6668
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Country | US
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Telephone | 206-612-3644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. REINHARD KNICKELBEIN
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Credential |
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Telephone | 206-612-3644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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