Provider Demographics
NPI:1801361738
Name:BEESTON HILL HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:BEESTON HILL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:EVORA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:340-778-8888
Mailing Address - Street 1:4060 ESTATE BEESTON HL
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4454
Mailing Address - Country:US
Mailing Address - Phone:340-778-8888
Mailing Address - Fax:340-692-5651
Practice Address - Street 1:23 BEESTON HILL
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-8888
Practice Address - Fax:340-692-5651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1104894765Medicaid
VI1639502925Medicaid