Provider Demographics
NPI:1275504896
Name:BEACON HEALTH SERVICES INC
Entity Type:Organization
Organization Name:BEACON HEALTH SERVICES INC
Other - Org Name:BEACON HOSPITAL & REHABILITATION OF POCATELLO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-251-1107
Mailing Address - Street 1:1200 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2708
Mailing Address - Country:US
Mailing Address - Phone:208-232-2570
Mailing Address - Fax:208-233-6769
Practice Address - Street 1:1200 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2708
Practice Address - Country:US
Practice Address - Phone:208-232-2570
Practice Address - Fax:208-233-6769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
134011Medicare ID - Type Unspecified