Provider Demographics
NPI:1508638545
Name:BEACON SPECIALIZED LIVING OHIO INC
Entity Type:Organization
Organization Name:BEACON SPECIALIZED LIVING OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF BIZ DEV & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:PELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-330-3073
Mailing Address - Street 1:967 WORTHINGTON WOODS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5743
Mailing Address - Country:US
Mailing Address - Phone:614-330-3073
Mailing Address - Fax:
Practice Address - Street 1:967 WORTHINGTON WOODS LOOP RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-5743
Practice Address - Country:US
Practice Address - Phone:614-330-3073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE COMMUNITY RESOURCES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care