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General NPI Number Information
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NPI Number | 1104573633
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Entity Type | Organization
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Legal Business Name | THE BEACON HOUSE ASSOCIATION OF SAN PEDRO
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 103 W. 11TH ST.
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City | SAN PEDRO
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State | CA
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Zip | 90731-4301
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Country | US
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Telephone | 310-514-4940
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 328
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City | SAN PEDRO
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State | CA
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Zip | 90733-0328
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Country | US
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Telephone | 310-514-4940
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | MR. JONATHAN HIGGINS
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Credential | CATC I
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Telephone | 310-514-4940
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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