Provider Demographics
NPI:1184230906
Name:BEACH HOUSE, INC.
Entity Type:Organization
Organization Name:BEACH HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLYDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-380-0116
Mailing Address - Street 1:2283 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1205
Mailing Address - Country:US
Mailing Address - Phone:419-244-2175
Mailing Address - Fax:419-244-2253
Practice Address - Street 1:2283 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1205
Practice Address - Country:US
Practice Address - Phone:419-244-2175
Practice Address - Fax:419-244-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)