Provider Demographics
NPI:1548423056
Name:BEACON THERAPY SERVICES
Entity Type:Organization
Organization Name:BEACON THERAPY SERVICES
Other - Org Name:NADEGE ALEXANDRE
Other - Org Type:Other Name
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:NADEGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALEXANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:917-554-5198
Mailing Address - Street 1:14711 240TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2453
Mailing Address - Country:US
Mailing Address - Phone:917-554-5198
Mailing Address - Fax:
Practice Address - Street 1:14711 240TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2453
Practice Address - Country:US
Practice Address - Phone:917-554-5198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities