MEDICARE: BEACON HEALTH & WELLNESS 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1538852421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON HEALTH & WELLNESS SERVICES LLC

Provider Business Mailing Address
First Line	:	7375 EXECUTIVE PL
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2278
Country	:	US
Telephone Number	:	301-828-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	7375 EXECUTIVE PL
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2278
Country	:	US
Telephone Number	:	301-828-9006
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EDITH EMELIFE
Credential	:	MSN, FNP, CRNP
Telephone Number	:	240-381-5413

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	05/29/2023

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