Provider Demographics
NPI:1235207226
Name:KAREN BEAGLES
Entity Type:Organization
Organization Name:KAREN BEAGLES
Other - Org Name:KB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEAGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-593-0338
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-0997
Mailing Address - Country:US
Mailing Address - Phone:801-593-0338
Mailing Address - Fax:
Practice Address - Street 1:59 KING ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4630
Practice Address - Country:US
Practice Address - Phone:801-593-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-ALI-74068310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid