Provider Demographics
NPI:1790110070
Name:BEACON SPECIALIZED LIVING SERVICES
Entity Type:Organization
Organization Name:BEACON SPECIALIZED LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF NURSE / HOUSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MANARY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:989-883-2600
Mailing Address - Street 1:628 E MAIN ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SEBEWAING
Mailing Address - State:MI
Mailing Address - Zip Code:48759-1698
Mailing Address - Country:US
Mailing Address - Phone:989-883-2600
Mailing Address - Fax:989-883-2601
Practice Address - Street 1:628 E MAIN ST APT 8
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-1698
Practice Address - Country:US
Practice Address - Phone:989-883-2600
Practice Address - Fax:989-883-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47030950123104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness