Healthcare Provider Details

I. General information

NPI: 1164856811
Provider Name (Legal Business Name): BECKETT SPRINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8614 SHEPHERD FARM DR
WEST CHESTER OH
45069-1128
US

IV. Provider business mailing address

8614 SHEPHERD FARM DR
WEST CHESTER OH
45069-1128
US

V. Phone/Fax

Practice location:
  • Phone: 513-942-9500
  • Fax: 513-942-9591
Mailing address:
  • Phone: 513-942-9500
  • Fax: 513-942-9591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA05175NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35088279
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-050898
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35081126
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number35050898
License Number StateOH

VIII. Authorized Official

Name: MS. DONNA SALEE WEST
Title or Position: DIRECTOR OF LICENSE AND REGULATION
Credential: RN
Phone: 812-598-8989