Healthcare Provider Details

I. General information

NPI: 1437236551
Provider Name (Legal Business Name): BEACON HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ATLANTIC PL STE 40
SOUTH PORTLAND ME
04106-2316
US

IV. Provider business mailing address

3854 AMERICAN WAY SUITE A
BATON ROUGE LA
70816-4013
US

V. Phone/Fax

Practice location:
  • Phone: 207-772-0929
  • Fax: 207-772-7779
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number36706
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number38312
License Number StateME

VIII. Authorized Official

Name: MR. PAUL B KUSSEROW
Title or Position: PRESIDENT
Credential:
Phone: 225-292-2031