1295620847 NPI number — MENIFEE MEADOWS NURSING & REHAB LLC

Table of content: DR. KATIE LYNN BEAUREGARD D.O. (NPI 1760863237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295620847 NPI number — MENIFEE MEADOWS NURSING & REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENIFEE MEADOWS NURSING & REHAB LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295620847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28603-1667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-324-8898
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 BERRYMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCHBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40322-8496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-768-9001
Provider Business Practice Location Address Fax Number:
606-768-9005
Provider Enumeration Date:
06/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
WOMACK
Authorized Official First Name:
BRYON
Authorized Official Middle Name:
D
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
828-334-5323

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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