Provider Demographics
NPI:1225693534
Name:BEACON POINTE
Entity Type:Organization
Organization Name:BEACON POINTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCKERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-775-1430
Mailing Address - Street 1:111 W FERRY ST
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1154
Mailing Address - Country:US
Mailing Address - Phone:269-465-7600
Mailing Address - Fax:
Practice Address - Street 1:732 E CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-5517
Practice Address - Country:US
Practice Address - Phone:269-775-1430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCKERTY HEALTH CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAL390381477OtherADULT FOSTER CARE