Provider Demographics
NPI:1265028971
Name:BEACON HEALTH VENTURES INC
Entity Type:Organization
Organization Name:BEACON HEALTH VENTURES INC
Other - Org Name:BEACON HOME CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WAIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-647-8674
Mailing Address - Street 1:3355 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1779
Mailing Address - Country:US
Mailing Address - Phone:574-647-8675
Mailing Address - Fax:574-647-8764
Practice Address - Street 1:3355 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1779
Practice Address - Country:US
Practice Address - Phone:574-647-8675
Practice Address - Fax:574-647-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies