Provider Demographics
NPI:1497436844
Name:BEACON HOUSE AFTERCARE PROGRAM
Entity Type:Organization
Organization Name:BEACON HOUSE AFTERCARE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:RUSS
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:502-581-0765
Mailing Address - Street 1:963 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2211
Mailing Address - Country:US
Mailing Address - Phone:502-581-0765
Mailing Address - Fax:502-581-1748
Practice Address - Street 1:963 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2211
Practice Address - Country:US
Practice Address - Phone:502-581-0765
Practice Address - Fax:502-581-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty