Provider Demographics
NPI:1720752181
Name:BEULAH HEALTH CARE PLLC
Entity Type:Organization
Organization Name:BEULAH HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:O
Authorized Official - Last Name:SAMUEL-OJO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:623-201-0084
Mailing Address - Street 1:1324 N FARRELL CT STE 109
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1945
Mailing Address - Country:US
Mailing Address - Phone:623-201-0084
Mailing Address - Fax:623-444-9566
Practice Address - Street 1:1324 N FARRELL CT STE 109
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1945
Practice Address - Country:US
Practice Address - Phone:623-201-0084
Practice Address - Fax:623-444-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty