Healthcare Provider Details

I. General information

NPI: 1225693534
Provider Name (Legal Business Name): BEACON POINTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 E CENTRE AVE
PORTAGE MI
49002-5517
US

IV. Provider business mailing address

111 W FERRY ST
BERRIEN SPRINGS MI
49103-1154
US

V. Phone/Fax

Practice location:
  • Phone: 269-775-1430
  • Fax:
Mailing address:
  • Phone: 269-465-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: TODD DOCKERTY
Title or Position: OWNER/COO
Credential:
Phone: 269-775-1430