Healthcare Provider Details

I. General information

NPI: 1396689592
Provider Name (Legal Business Name): BEACON OF HOPE THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL STE EB1160
DAYTON OH
45417-3445
US

IV. Provider business mailing address

1 ELIZABETH PL STE EB1160
DAYTON OH
45417-3445
US

V. Phone/Fax

Practice location:
  • Phone: 937-559-1688
  • Fax:
Mailing address:
  • Phone: 937-559-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICHOLINE EFUNDEM OROCK
Title or Position: MANAGING MEMBER
Credential: DNP, PMHNP-BC
Phone: 937-559-1688