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General NPI Number Information
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NPI Number | 1710564844
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Entity Type | Organization
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Legal Business Name | BEACON IN HOME HEALTH LLC
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 57 HOMEGROWN WAY UNIT 603
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City | YULEE
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State | FL
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Zip | 32097-0180
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Country | US
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Telephone | 904-867-8900
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Fax | 904-551-5017
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Provider Business Mailing Address
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Address Line | 57 HOMEGROWN WAY UNIT 603
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City | YULEE
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State | FL
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Zip | 32097-0180
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Country | US
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Telephone | 904-867-8900
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Fax | 904-551-5017
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Authorized Official
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Title or Position | OWNER
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Name | GRAHAM A WOOD
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Credential |
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Telephone | 608-515-0183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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