Provider Demographics
NPI:1467794156
Name:BEACON HEALTH SERVICES
Entity Type:Organization
Organization Name:BEACON HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:OLADISUN
Authorized Official - Last Name:FOFANAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-277-8415
Mailing Address - Street 1:2750 HOLLY HALL ST
Mailing Address - Street 2:1512
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2750 HOLLY HALL ST
Practice Address - Street 2:1512
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4109
Practice Address - Country:US
Practice Address - Phone:832-277-8415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health