MEDICARE: SUSAN BECKWITH

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	AF630287239	MI

General Provider Information

NPI Number	:	1669901641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BECKWITH

Provider Business Mailing Address
First Line	:	2230 ROCHESTER RD
Second Line	:
City	:	LEONARD
State	:	MI
Zip	:	48367-3002
Country	:	US
Telephone Number	:	248-628-7123
Fax Number	:	248-628-7123

Provider Business Practice Location Address
First Line	:	2230 ROCHESTER RD
Second Line	:
City	:	LEONARD
State	:	MI
Zip	:	48367-3002
Country	:	US
Telephone Number	:	248-083-0619
Fax Number	:	248-628-7123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	06/05/2017

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Directions to “ SUSAN BECKWITH ” Practice Location

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