Provider Demographics
NPI:1477101301
Name:BEACHSIDE HOME SERVICE, LLC
Entity Type:Organization
Organization Name:BEACHSIDE HOME SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-508-8115
Mailing Address - Street 1:101 E MARKET ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3980
Mailing Address - Country:US
Mailing Address - Phone:919-938-8112
Mailing Address - Fax:
Practice Address - Street 1:101 E MARKET ST STE 2C
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3980
Practice Address - Country:US
Practice Address - Phone:919-938-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No347C00000XTransportation ServicesPrivate Vehicle