Healthcare Provider Details

I. General information

NPI: 1336223031
Provider Name (Legal Business Name): BEACON HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 BRICKYARD CT
YORK ME
03909-1601
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 207-351-3020
  • Fax: 207-351-1188
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number36451
License Number StateME

VIII. Authorized Official

Name: MR. WILLIAM F BORNE
Title or Position: PRESIDENT
Credential:
Phone: 225-292-2031