Healthcare Provider Details

I. General information

NPI: 1851206676
Provider Name (Legal Business Name): HEATHER DAWN BEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 NE ROSE RIDGE DR
WINSTON OR
97496-6601
US

IV. Provider business mailing address

208 NE ROSE RIDGE DR
WINSTON OR
97496-6601
US

V. Phone/Fax

Practice location:
  • Phone: 209-451-8168
  • Fax:
Mailing address:
  • Phone: 209-451-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: