Provider Demographics
NPI:1013589910
Name:BEATRIX LLC
Entity Type:Organization
Organization Name:BEATRIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADEBUKOLA
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:ORISADARE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:708-299-2318
Mailing Address - Street 1:43644 ARBORVIEW LN
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3347
Mailing Address - Country:US
Mailing Address - Phone:708-299-2318
Mailing Address - Fax:
Practice Address - Street 1:43644 ARBORVIEW LN
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-3347
Practice Address - Country:US
Practice Address - Phone:708-299-2318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty