Provider Demographics
NPI:1871787382
Name:BECTON ENTERPRISES
Entity type:Organization
Organization Name:BECTON ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:BECTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:813-929-7067
Mailing Address - Street 1:12909 56TH ST N STE 204
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617
Mailing Address - Country:US
Mailing Address - Phone:813-929-7067
Mailing Address - Fax:813-985-1255
Practice Address - Street 1:12909 56TH ST STE 204
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617
Practice Address - Country:US
Practice Address - Phone:813-929-7067
Practice Address - Fax:813-985-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211314251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691850600Medicaid