Healthcare Provider Details

I. General information

NPI: 1396423463
Provider Name (Legal Business Name): BEACON HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19590 W SAN MIGUEL AVE
LITCHFIELD PARK AZ
85340-5422
US

IV. Provider business mailing address

19590 W SAN MIGUEL AVE
LITCHFIELD PARK AZ
85340-5422
US

V. Phone/Fax

Practice location:
  • Phone: 623-377-0825
  • Fax:
Mailing address:
  • Phone: 623-377-0825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM FOX
Title or Position: OWNER
Credential: DNP
Phone: 623-377-0825