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NPI Code Detail

MEDICARE: BEACON HEALTH VENTURES, INC.

MEDICARE: BEACON HEALTH VENTURES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency15-005298-1IN

General Provider Information

NPI Number : 1053675363
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACON HEALTH VENTURES, INC.
Provider Business Mailing Address
First Line : 3355 DOUGLAS RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1781
Country : US
Telephone Number : 574-647-8731
Fax Number : 574-647-8768
Provider Business Practice Location Address
First Line : 5155 VERDANT DRIVE
Second Line :
City : ELKHART
State : IN
Zip : 46516-5411
Country : US
Telephone Number : 574-294-6181
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : SANDRA SMIGIELSKI
Credential :
Telephone Number : 574-647-8731
Provider Enumeration Date : 07/02/2012
Last Update Date : 02/16/2018

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Directions to “BEACON HEALTH VENTURES, INC. ” Practice Location

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