MEDICARE: BEACON HEALTH SERVICES

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1467794156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2750 HOLLY HALL ST
Second Line	:	1512
City	:	HOUSTON
State	:	TX
Zip	:	77054-4109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 HOLLY HALL ST
Second Line	:	1512
City	:	HOUSTON
State	:	TX
Zip	:	77054-4109
Country	:	US
Telephone Number	:	832-277-8415
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. NICHOLAS OLADISUN FOFANAH
Credential	:
Telephone Number	:	832-277-8415

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	03/20/2013

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Directions to “BEACON HEALTH SERVICES ” Practice Location

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