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General NPI Number Information
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NPI Number | 1528174349
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Entity Type | Organization
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Legal Business Name | BEACON SPECIALIZED LIVING MINNESOTA, INC.
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 1355 MENDOTA HEIGHTS ROAD SUITE 260
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120
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Country | US
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Telephone | 651-451-2889
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Fax | 651-451-5955
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Provider Business Mailing Address
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Address Line | 1355 MENDOTA HEIGHTS ROAD SUITE 260
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120
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Country | US
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Telephone | 651-451-2889
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Fax | 651-451-5955
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | BARBARA TURNER
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Credential |
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Telephone | 651-451-2889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP2482
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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