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General NPI Number Information
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NPI Number | 1538706890
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Entity Type | Organization
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Legal Business Name | B.E.A. SERVICES LLC
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 3625 SE 5TH PL
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City | RENTON
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State | WA
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Zip | 98058-2836
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Country | US
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Telephone | 206-300-5086
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Fax |
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Provider Business Mailing Address
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Address Line | PMB 5054 P.O. BOX 257
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City | OLYMPIA
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State | WA
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Zip | 98507
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Country | US
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Telephone | 206-300-5086
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | TELLEY P WORMLEY
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Credential | HCA
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Telephone | 206-300-5086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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