Provider Demographics
NPI:1164202560
Name:BEACON SPECIALIZED LIVING OHIO INC
Entity Type:Organization
Organization Name:BEACON SPECIALIZED LIVING OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPS/BIZ DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:PELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-330-3073
Mailing Address - Street 1:967 WORTHINGTON WOODS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2039 LAKEVIEW DR STE 110
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1004
Practice Address - Country:US
Practice Address - Phone:614-330-3073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE COMMUNITY RESOURCES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities