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General NPI Number Information
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NPI Number | 1699594812
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Entity Type | Organization
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Legal Business Name | BEACON OUTREACH INITIATIVES LLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 619 E 116TH PL
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City | LOS ANGELES
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State | CA
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Zip | 90059-2311
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Country | US
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Telephone | 714-864-0735
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 WEST 85TH STREET
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City | LA
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State | CA
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Zip | 90048
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Country | US
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Telephone | 323-472-7784
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | KOBINA S SACKEY
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Credential |
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Telephone | 714-864-0735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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