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General NPI Number Information
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NPI Number | 1639504913
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Entity Type | Organization
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Legal Business Name | BEACON SPECIALIZED LIVING SERVICES
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 9284 STATE HIGHWAY M35
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City | GLADSTONE
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State | MI
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Zip | 49837-8801
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Country | US
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Telephone | 906-420-8446
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Fax | 866-846-9240
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Provider Business Mailing Address
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Address Line | 9284 STATE HIGHWAY M35
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City | GLADSTONE
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State | MI
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Zip | 49837-8801
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Country | US
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Telephone | 906-420-8446
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Fax | 866-846-9240
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Authorized Official
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Title or Position | STAFF NURSE / ASSISTANT HOME MANAGE
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Name | MARCI JUNE ANDERSON
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Credential | RN
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Telephone | 906-420-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 4704258587
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License Number State | MI
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