Healthcare Provider Details

I. General information

NPI: 1275504896
Provider Name (Legal Business Name): BEACON HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HOSPITAL WAY
POCATELLO ID
83201-2708
US

IV. Provider business mailing address

1200 HOSPITAL WAY
POCATELLO ID
83201-2708
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-2570
  • Fax: 208-233-6769
Mailing address:
  • Phone: 208-232-2570
  • Fax: 208-233-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number59
License Number StateID

VIII. Authorized Official

Name: CRAE T BERRETT
Title or Position: OWNER
Credential:
Phone: 208-251-1107