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General NPI Number Information
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NPI Number | 1205948338
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Entity Type | Organization
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Legal Business Name | BEADLES, INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 916 NOBLE ST
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City | ALVA
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State | OK
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Zip | 73717-2852
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Country | US
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Telephone | 580-327-1274
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Fax | 580-327-2937
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Provider Business Mailing Address
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Address Line | PO BOX 728
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City | ALVA
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State | OK
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Zip | 73717-0728
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Country | US
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Telephone | 580-327-1274
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Fax | 580-327-2937
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. MARY RUTH HIETT
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Credential | LPN OK #L0010078
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Telephone | 580-327-5309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH7601-7601
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License Number State | OK
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