Provider Demographics
NPI:1700049293
Name:BEACON FOR LIFE, ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:BEACON FOR LIFE, ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRY
Authorized Official - Suffix:III
Authorized Official - Credentials:JD
Authorized Official - Phone:225-246-8867
Mailing Address - Street 1:5500 FLORIDA BLVD
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4133
Mailing Address - Country:US
Mailing Address - Phone:225-246-8867
Mailing Address - Fax:225-218-0074
Practice Address - Street 1:5500 FLORIDA BLVD
Practice Address - Street 2:SUITE 103B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4133
Practice Address - Country:US
Practice Address - Phone:225-246-8867
Practice Address - Fax:225-218-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-06
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA15065251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPCA15065Medicaid