Healthcare Provider Details

I. General information

NPI: 1427003359
Provider Name (Legal Business Name): BEACON HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35410 DEL REY
CAPISTRANO BEACH CA
92624-1814
US

IV. Provider business mailing address

35410 DEL REY
CAPISTRANO BEACH CA
92624-1814
US

V. Phone/Fax

Practice location:
  • Phone: 949-496-5786
  • Fax: 949-496-0540
Mailing address:
  • Phone: 949-496-5786
  • Fax: 949-496-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: CRAE TYLER BERRETT
Title or Position: PRESIDENT
Credential:
Phone: 208-251-1107