Provider Demographics
NPI:1912305210
Name:BEAUSEJOUR PERSONAL CARE LLC
Entity Type:Organization
Organization Name:BEAUSEJOUR PERSONAL CARE LLC
Other - Org Name:BEAUSEJOUR PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:PETERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-288-5648
Mailing Address - Street 1:11426 KIRKHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2226
Mailing Address - Country:US
Mailing Address - Phone:832-288-5648
Mailing Address - Fax:281-741-5024
Practice Address - Street 1:11426 KIRKHOLLOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2226
Practice Address - Country:US
Practice Address - Phone:832-288-5648
Practice Address - Fax:281-741-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care