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General NPI Number Information
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NPI Number | 1033274485
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Entity Type | Organization
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Legal Business Name | BEACON HOUSE
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 468 PINE AVE
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City | PACIFIC GROVE
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State | CA
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Zip | 93950-3440
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Country | US
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Telephone | 831-372-2334
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Fax | 831-372-2396
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Provider Business Mailing Address
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Address Line | PO BOX 301
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City | PACIFIC GROVE
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State | CA
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Zip | 93950-0301
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Country | US
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Telephone | 831-372-2334
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Fax | 831-372-2396
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Authorized Official
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Title or Position | CEO
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Name | MR. MARK WILLISON
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Credential | MFT
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Telephone | 831-372-2334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 270001AN
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License Number State | CA
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