MEDICARE: BEACON INTEGRATED HEALTHCARE SERVICES, 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	261QD1600X	Developmental Disabilities Clinic/Center
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1841987104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON INTEGRATED HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	6400 BALTIMORE NATIONAL PIKE STE 250B
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-3947
Country	:	US
Telephone Number	:	443-860-9257
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 BALTIMORE NATIONAL PIKE STE 250B
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-3947
Country	:	US
Telephone Number	:	443-860-9257
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ADEYINKA WINDAPO
Credential	:
Telephone Number	:	443-860-9257

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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