MEDICARE: BEAUVAIS HOMECARE SERVICES 1 INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	240238	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1013742774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUVAIS HOMECARE SERVICES 1 INC

Provider Business Mailing Address
First Line	:	6453 PEMBROKE RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33023-2137
Country	:	US
Telephone Number	:	954-859-6294
Fax Number	:	954-859-6152

Provider Business Practice Location Address
First Line	:	19111 COLLINS AVE
Second Line	:
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-2376
Country	:	US
Telephone Number	:	954-859-6294
Fax Number	:	954-859-6152

Authorized Official
Title or Position	:	OWNER
Name	:	WILDA B BEAUVAIS
Credential	:
Telephone Number	:	954-859-6294

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	09/03/2024

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