Provider Demographics
NPI:1245627918
Name:BEACHLAND RETIREMENT HOME INC.
Entity type:Organization
Organization Name:BEACHLAND RETIREMENT HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULHERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-979-1300
Mailing Address - Street 1:462 HERNANDO ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34949-3243
Mailing Address - Country:US
Mailing Address - Phone:772-979-1300
Mailing Address - Fax:
Practice Address - Street 1:462 HERNANDO ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34949-3243
Practice Address - Country:US
Practice Address - Phone:772-979-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8841310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility