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General NPI Number Information
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NPI Number | 1790859403
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Entity Type | Organization
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Legal Business Name | BEACON HEALTH VENTURES INC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 3355 DOUGLAS RD
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City | SOUTH BEND
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State | IN
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Zip | 46635-1779
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Country | US
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Telephone | 574-647-8675
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Fax | 574-647-8764
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Provider Business Mailing Address
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Address Line | 3355 DOUGLAS RD
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City | SOUTH BEND
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State | IN
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Zip | 46635-1779
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Country | US
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Telephone | 574-647-8675
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Fax | 574-647-8764
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Authorized Official
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Title or Position | MANAGER
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Name | TRUDY K WAIT
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Credential |
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Telephone | 574-647-8674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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Taxonomy #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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