Provider Demographics
NPI:1144104142
Name:BEAUFORT ENTERPRISES LLC
Entity type:Organization
Organization Name:BEAUFORT ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REINHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KNICKELBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-612-3644
Mailing Address - Street 1:1362 E NEST VIEW CT
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6668
Mailing Address - Country:US
Mailing Address - Phone:206-612-3644
Mailing Address - Fax:
Practice Address - Street 1:3023 E COPPER POINT DR STE 207
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9290
Practice Address - Country:US
Practice Address - Phone:208-357-4595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUFORT ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care