Provider Demographics
NPI:1942594940
Name:BEULAH HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:BEULAH HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-525-9037
Mailing Address - Street 1:3613 ROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1635
Mailing Address - Country:US
Mailing Address - Phone:903-525-9037
Mailing Address - Fax:903-525-9076
Practice Address - Street 1:3613 ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-1635
Practice Address - Country:US
Practice Address - Phone:903-525-9037
Practice Address - Fax:903-525-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3368433Medicaid
TX747788Medicare PIN