Provider Demographics
NPI:1306124169
Name:BEALLS CORPORATION
Entity type:Organization
Organization Name:BEALLS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-721-4790
Mailing Address - Street 1:402 S RAGSDALE ST
Mailing Address - Street 2:SUIT 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-4993
Mailing Address - Country:US
Mailing Address - Phone:903-721-4790
Mailing Address - Fax:
Practice Address - Street 1:905 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2705
Practice Address - Country:US
Practice Address - Phone:903-721-4790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care