Healthcare Provider Details

I. General information

NPI: 1427278092
Provider Name (Legal Business Name): BEACON ARMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W. BUNCOMBE STREET
ROPER NC
27970
US

IV. Provider business mailing address

2294 GALLBERRY RD
WASHINGTON NC
27889-9178
US

V. Phone/Fax

Practice location:
  • Phone: 252-791-0002
  • Fax: 252-791-0772
Mailing address:
  • Phone: 252-946-6617
  • Fax: 252-946-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberHAL094005
License Number StateNC

VIII. Authorized Official

Name: MISS TIFFANY COLLETTE EVERETT
Title or Position: PRESIDENT
Credential:
Phone: 252-946-6617