Joseph R Beauchamp

Individual provider Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Grass Valley, CA

NPI 1043633779 · NPPES record last updated Jan 31, 2014

Key facts

NPI
1043633779
Entity type
Individual (NPI type 1)
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
Practice address
714 W. Main St
Grass Valley, CA 95945
Phone
(530) 477-9800
Fax
(530) 477-9803
NPI assigned
Jan 31, 2014
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Yes

Addresses

Primary practice location

714 W. Main St
Grass Valley, CA 95945

Mailing address

714 W. Main St
Grass Valley, CA 95945
Phone (530) 477-9800

Other providers in Grass Valley, CA

All providers in Grass Valley, CA · Emotionally Disturbed Childrens' Residential Treatment Facility in California

Sources for this page

Verify at the official NPI Registry.