Healthcare Provider Details

I. General information

NPI: 1568119394
Provider Name (Legal Business Name): BEACONS OF HOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LN STE 106
HAZARD KY
41701-9524
US

IV. Provider business mailing address

PO BOX 2011
HAZARD KY
41702-2011
US

V. Phone/Fax

Practice location:
  • Phone: 606-435-7557
  • Fax: 606-435-7516
Mailing address:
  • Phone: 606-435-7557
  • Fax: 606-435-7516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BARRY K MARTIN
Title or Position: CEO/OWNER
Credential:
Phone: 606-438-3181