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General NPI Number Information
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NPI Number | 1912796699
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Entity Type | Organization
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Legal Business Name | BEACON HEALTH, LLC
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 202 LINCOLNWAY E STE 200
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City | MISHAWAKA
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State | IN
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Zip | 46544-2079
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Country | US
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Telephone | 574-647-2301
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Fax | 574-647-2302
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DR STE 100
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City | GRANGER
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State | IN
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Zip | 46530-1380
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Country | US
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Telephone | 574-647-1070
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JEFFREY COSTELLO
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Credential |
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Telephone | 574-647-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) 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 | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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