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General NPI Number Information
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NPI Number | 1861945511
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Entity Type | Organization
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Legal Business Name | BEETON PROVIDER SERVICES, INC.
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 1566 W 1ST AVE
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City | GRANDVIEW
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State | OH
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Zip | 43212-3346
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Country | US
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Telephone | 614-529-6562
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Fax | 614-559-6619
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Provider Business Mailing Address
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Address Line | 1566 W 1ST AVE
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City | GRANDVIEW
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State | OH
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Zip | 43212-3346
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Country | US
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Telephone | 614-529-6562
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Fax | 614-559-6619
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. STEVE HAMM
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Credential | MBA
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Telephone | 614-529-6562
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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 | 2507540
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License Number State | OH
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