Provider Demographics
NPI:1710564844
Name:BEACON IN HOME HEALTH LLC
Entity Type:Organization
Organization Name:BEACON IN HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-515-0183
Mailing Address - Street 1:57 HOMEGROWN WAY UNIT 603
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-0180
Mailing Address - Country:US
Mailing Address - Phone:904-867-8900
Mailing Address - Fax:904-551-5017
Practice Address - Street 1:57 HOMEGROWN WAY UNIT 603
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-0180
Practice Address - Country:US
Practice Address - Phone:904-867-8900
Practice Address - Fax:904-551-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health