MEDICARE: BEACON SPECIALIZED LIVING OHIO INC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1508638545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON SPECIALIZED LIVING OHIO INC

Provider Business Mailing Address
First Line	:	967 WORTHINGTON WOODS LOOP RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43085-5743
Country	:	US
Telephone Number	:	614-330-3073
Fax Number	:

Provider Business Practice Location Address
First Line	:	967 WORTHINGTON WOODS LOOP RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43085-5743
Country	:	US
Telephone Number	:	614-330-3073
Fax Number	:

Authorized Official
Title or Position	:	VP OF BIZ DEV & OPERATIONS
Name	:	JANET L PELL
Credential	:
Telephone Number	:	614-330-3073

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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