Provider Demographics
NPI:1386990778
Name:BEULAH HEALTHCARE SERVICES INC.
Entity type:Organization
Organization Name:BEULAH HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:OGUNMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MHA/INFO
Authorized Official - Phone:301-257-5788
Mailing Address - Street 1:4103 BRIDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-8049
Mailing Address - Country:US
Mailing Address - Phone:301-257-5788
Mailing Address - Fax:301-627-3234
Practice Address - Street 1:4103 BRIDLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-8049
Practice Address - Country:US
Practice Address - Phone:301-257-5788
Practice Address - Fax:301-627-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities