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General NPI Number Information
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NPI Number | 1306124169
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Entity Type | Organization
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Legal Business Name | BEALLS CORPORATION
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 905 EDGEWOOD DR
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2705
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Country | US
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Telephone | 903-721-4790
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Fax |
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Provider Business Mailing Address
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Address Line | 402 S RAGSDALE ST SUIT 203
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City | JACKSONVILLE
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State | TX
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Zip | 75766-4993
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Country | US
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Telephone | 903-721-4790
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | MR. JEREMY RAY BEALL
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Credential |
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Telephone | 903-721-4790
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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 | TX
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