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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251F00000X | Agencies | Home Infusion | |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |