Provider Demographics
NPI:1093569402
Name:BEULAH SPRING ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:BEULAH SPRING ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:OTON
Authorized Official - Last Name:EKONG
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:240-602-7099
Mailing Address - Street 1:13908 EDSALL ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6849
Mailing Address - Country:US
Mailing Address - Phone:240-602-7099
Mailing Address - Fax:
Practice Address - Street 1:13908 EDSALL ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6849
Practice Address - Country:US
Practice Address - Phone:240-602-7099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility