Healthcare Provider Details

I. General information

NPI: 1801716121
Provider Name (Legal Business Name): BEACON RESIDENTIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 PROSPECT ST
MANCHESTER NH
03104-3762
US

IV. Provider business mailing address

12 PATRICIA ST
WINDHAM NH
03087-2223
US

V. Phone/Fax

Practice location:
  • Phone: 857-320-1277
  • Fax:
Mailing address:
  • Phone: 857-320-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DIAMOND BOONE
Title or Position: FOUNDER/ ADMINISTRATOR
Credential: BOONE
Phone: 857-320-1277