Provider Demographics
NPI:1013742774
Name:BEAUVAIS HOMECARE SERVICES 1 INC
Entity type:Organization
Organization Name:BEAUVAIS HOMECARE SERVICES 1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BEAUVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-859-6294
Mailing Address - Street 1:6453 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2137
Mailing Address - Country:US
Mailing Address - Phone:954-859-6294
Mailing Address - Fax:954-859-6152
Practice Address - Street 1:19111 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2376
Practice Address - Country:US
Practice Address - Phone:954-859-6294
Practice Address - Fax:954-859-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL240238OtherAHCA