Provider Demographics
NPI:1447956032
Name:BEEBE, RAYMOND PAUL
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PAUL
Last Name:BEEBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13242 N 34TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1217
Mailing Address - Country:US
Mailing Address - Phone:602-978-8005
Mailing Address - Fax:602-795-5665
Practice Address - Street 1:13242 N 34TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1217
Practice Address - Country:US
Practice Address - Phone:602-978-8005
Practice Address - Fax:602-795-5665
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10095310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility