MEDICARE: BEACON BEHAVIOR CARE SERVICES, LLC

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174211742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON BEHAVIOR CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	13499 BISCAYNE BLVD.
Second Line	:	#CU 106, UNIT I
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2043
Country	:	US
Telephone Number	:	305-316-1972
Fax Number	:

Provider Business Practice Location Address
First Line	:	13499 BISCAYNE BLVD.
Second Line	:	#CU 106, UNIT I
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2043
Country	:	US
Telephone Number	:	305-316-1972
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	LILLIAM MENENDEZ
Credential	:
Telephone Number	:	305-316-1972

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/08/2023

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