Provider Demographics
NPI:1023208048
Name:BEACON OF HOPE HOUSE
Entity Type:Organization
Organization Name:BEACON OF HOPE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:DIAZ
Authorized Official - Last Name:TAVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:212-371-1011
Mailing Address - Street 1:1011 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4112
Mailing Address - Country:US
Mailing Address - Phone:212-371-1011
Mailing Address - Fax:212-350-9948
Practice Address - Street 1:1011 1ST AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4112
Practice Address - Country:US
Practice Address - Phone:212-371-1011
Practice Address - Fax:212-350-9948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES COMMUNITY SERVICES, ARCHDIOCESE OF NEW YORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-26
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0312954320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0312954Medicaid