Provider Demographics
NPI:1649042292
Name:EUSTACHE, BEATRICE POULARD
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:POULARD
Last Name:EUSTACHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-7766
Mailing Address - Country:US
Mailing Address - Phone:331-302-2223
Mailing Address - Fax:954-990-8668
Practice Address - Street 1:413 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7766
Practice Address - Country:US
Practice Address - Phone:331-302-2223
Practice Address - Fax:954-990-8668
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities