Provider Demographics
NPI:1326429630
Name:BEACON PLACE LLC
Entity Type:Organization
Organization Name:BEACON PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SOLMON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOVITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-928-2642
Mailing Address - Street 1:583 STATE ROUTE 32
Mailing Address - Street 2:5U
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-5200
Mailing Address - Country:US
Mailing Address - Phone:845-928-2642
Mailing Address - Fax:845-928-2989
Practice Address - Street 1:583 STATE ROUTE 32
Practice Address - Street 2:5U
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-5200
Practice Address - Country:US
Practice Address - Phone:845-928-2642
Practice Address - Fax:845-928-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care