Healthcare Provider Details

I. General information

NPI: 1841987104
Provider Name (Legal Business Name): BEACON INTEGRATED HEALTHCARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 BALTIMORE NATIONAL PIKE STE 250B
CATONSVILLE MD
21228-3947
US

IV. Provider business mailing address

6400 BALTIMORE NATIONAL PIKE STE 250B
CATONSVILLE MD
21228-3947
US

V. Phone/Fax

Practice location:
  • Phone: 443-860-9257
  • Fax:
Mailing address:
  • Phone: 443-860-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADEYINKA WINDAPO
Title or Position: CEO
Credential:
Phone: 443-860-9257