Provider Demographics
NPI:1831793223
Name:BEAGUE, GARPHARD
Entity type:Individual
Prefix:MR
First Name:GARPHARD
Middle Name:
Last Name:BEAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5314 LINDER PL
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3734
Mailing Address - Country:US
Mailing Address - Phone:813-406-3832
Mailing Address - Fax:
Practice Address - Street 1:3247 THORNY RIDGE DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-1554
Practice Address - Country:US
Practice Address - Phone:813-406-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL818144Medicaid