Provider Demographics
NPI:1134126741
Name:BEAUMONT HOME HEALTH SERVICE, INC
Entity Type:Organization
Organization Name:BEAUMONT HOME HEALTH SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:CONSTANT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, EDD
Authorized Official - Phone:361-578-0762
Mailing Address - Street 1:3202 SAM HOUSTON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2240
Mailing Address - Country:US
Mailing Address - Phone:361-578-0762
Mailing Address - Fax:361-578-1567
Practice Address - Street 1:1725 WEST CARDINAL DRIVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-6415
Practice Address - Country:US
Practice Address - Phone:409-833-4632
Practice Address - Fax:409-833-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003147251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003147OtherSTATE LICENSE NUMBER
TX023501201Medicaid
TX003147OtherSTATE LICENSE NUMBER