=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538977301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEAUVAIS HEALTH HOMECARE 3 INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2024
-----------------------------------------------------
Last Update Date | 12/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 NORTHFIELD AVE STE 208A
-----------------------------------------------------
City | WEST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07052-4730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-436-5862
-----------------------------------------------------
Fax | 973-537-1006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 594 SW 159TH LN
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-1152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-997-5842
-----------------------------------------------------
Fax | 954-859-6152
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | DR. WILDA B BEAUVAIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-436-5862
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SS0200X
-----------------------------------------------------
Taxonomy Name | School Clinical Nurse Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WC1400X
-----------------------------------------------------
Taxonomy Name | College Health Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------