Provider Demographics
NPI:1497145544
Name:BEACON INDUSTRIES
Entity Type:Organization
Organization Name:BEACON INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-505-6681
Mailing Address - Street 1:2651 POYDRAS ST
Mailing Address - Street 2:SUITE 2411
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7579
Mailing Address - Country:US
Mailing Address - Phone:504-230-9848
Mailing Address - Fax:
Practice Address - Street 1:2651 POYDRAS ST
Practice Address - Street 2:SUITE 2411
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7579
Practice Address - Country:US
Practice Address - Phone:504-230-9848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011207900343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)