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General NPI Number Information
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NPI Number | 1023755337
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Entity Type | Organization
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Legal Business Name | BEACON COMMUNITY CARE LLC
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 10800 LYNDALE AVE S STE 165
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City | BLOOMINGTON
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State | MN
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Zip | 55420-5698
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Country | US
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Telephone | 612-439-3634
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Fax | 612-439-3674
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Provider Business Mailing Address
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Address Line | 10800 LYNDALE AVE S STE 355
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City | BLOOMINGTON
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State | MN
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Zip | 55420-5644
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Country | US
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Telephone | 612-439-3634
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Fax | 612-439-3674
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MUHYEDIN RASHID DJIRDI
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Credential |
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Telephone | 612-412-4894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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