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General NPI Number Information
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NPI Number | 1023208048
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Entity Type | Organization
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Legal Business Name | BEACON OF HOPE HOUSE
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 1011 1ST AVE 11TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10022-4112
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Country | US
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Telephone | 212-371-1011
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Fax | 212-350-9948
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Provider Business Mailing Address
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Address Line | 1011 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10022-4112
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Country | US
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Telephone | 212-371-1011
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Fax | 212-350-9948
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BEATRIZ DIAZ TAVERAS
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Credential | MBA
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Telephone | 212-371-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 0312954
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License Number State | NY
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