Provider Demographics
NPI:1003017195
Name:LYNETTE R. BEADLES
Entity Type:Organization
Organization Name:LYNETTE R. BEADLES
Other - Org Name:RAMKOTA HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BEADLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-878-8129
Mailing Address - Street 1:16981 PLACER HILLS RD
Mailing Address - Street 2:B-7
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722
Mailing Address - Country:US
Mailing Address - Phone:530-878-8129
Mailing Address - Fax:530-878-8195
Practice Address - Street 1:16981 PLACER HILLS RD
Practice Address - Street 2:B-7
Practice Address - City:MEADOW VISTA
Practice Address - State:CA
Practice Address - Zip Code:95722
Practice Address - Country:US
Practice Address - Phone:530-878-8129
Practice Address - Fax:530-878-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty