Provider Demographics
NPI:1891321345
Name:BEASLEY, ROSIE F (NEMT SERVICES)
Entity Type:Individual
Prefix:MISS
First Name:ROSIE
Middle Name:F
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:NEMT SERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37336 CAMELLIA LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2018
Mailing Address - Country:US
Mailing Address - Phone:586-422-2879
Mailing Address - Fax:
Practice Address - Street 1:4458 GRAYTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-4006
Practice Address - Country:US
Practice Address - Phone:586-422-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB240744261924172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver