Provider Demographics
NPI:1205948338
Name:BEADLES, INC.
Entity type:Organization
Organization Name:BEADLES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:HIETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN OK #L0010078
Authorized Official - Phone:580-327-5309
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-0728
Mailing Address - Country:US
Mailing Address - Phone:580-327-1274
Mailing Address - Fax:580-327-2937
Practice Address - Street 1:916 NOBLE ST
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2852
Practice Address - Country:US
Practice Address - Phone:580-327-1274
Practice Address - Fax:580-327-2937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH7601-7601313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100773610AMedicaid