Provider Demographics
NPI:1578554325
Name:BEACON HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:BEACON HEALTHCARE SERVICES, INC.
Other - Org Name:NEWPORT BAY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT BUSINESS SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-650-9750
Mailing Address - Street 1:1501 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5924
Mailing Address - Country:US
Mailing Address - Phone:949-650-9750
Mailing Address - Fax:949-650-9768
Practice Address - Street 1:1501 E 16TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5924
Practice Address - Country:US
Practice Address - Phone:949-650-9750
Practice Address - Fax:949-650-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000160283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP34135FMedicaid
CA054135Medicare Oscar/Certification