Provider Demographics
NPI:1497765671
Name:BETELGEUSE, INC
Entity Type:Organization
Organization Name:BETELGEUSE, INC
Other - Org Name:HEARTLAND SPEECH THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:PACE-AUBREY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:863-381-4276
Mailing Address - Street 1:PO BOX 1586
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33871-1586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3124
Practice Address - Country:US
Practice Address - Phone:863-381-4276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889022600Medicaid
FLS2368OtherBCBS