MEDICARE: BEACON HOSPICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	36706	ME
2	251G00000X	Community Based Hospice Care Agency	38312	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437236551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON HOSPICE, LLC

Provider Business Mailing Address
First Line	:	3854 AMERICAN WAY
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4013
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	40 ATLANTIC PL STE 40
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2316
Country	:	US
Telephone Number	:	207-772-0929
Fax Number	:	207-772-7779

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL B KUSSEROW
Credential	:
Telephone Number	:	225-292-2031

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	10/06/2017

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