Provider Demographics
NPI:1679698807
Name:BEAUMONT RETIREMENT SERVICES, INC.
Entity Type:Organization
Organization Name:BEAUMONT RETIREMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:FORTENBAUGH
Authorized Official - Suffix:III
Authorized Official - Credentials:NHA, MBA
Authorized Official - Phone:610-526-7000
Mailing Address - Street 1:601 N ITHAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1782
Mailing Address - Country:US
Mailing Address - Phone:610-526-7000
Mailing Address - Fax:610-526-7118
Practice Address - Street 1:601 N ITHAN AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1782
Practice Address - Country:US
Practice Address - Phone:610-526-7000
Practice Address - Fax:610-526-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA849466261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070404Medicare ID - Type UnspecifiedOUTPATIENT DEPARTMENT