MEDICARE: BEACON INDUSTRIES 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
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1154728491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON INDUSTRIES INC.

Provider Business Mailing Address
First Line	:	2651 POYDRAS ST
Second Line	:	SUITE 2411
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-7579
Country	:	US
Telephone Number	:	504-230-9848
Fax Number	:	504-658-4502

Provider Business Practice Location Address
First Line	:	2651 POYDRAS ST
Second Line	:	SUITE 2411
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-7579
Country	:	US
Telephone Number	:	504-230-9848
Fax Number	:	504-658-4502

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. NICOLE COUSIN
Credential	:
Telephone Number	:	504-230-9848

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	12/02/2014

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