Provider Demographics
NPI:1790974053
Name:BEACON WAY II LLC
Entity Type:Organization
Organization Name:BEACON WAY II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORSLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-726-3734
Mailing Address - Street 1:5658 STATE HIGHWAY J
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:MO
Mailing Address - Zip Code:64402-8113
Mailing Address - Country:US
Mailing Address - Phone:660-726-3734
Mailing Address - Fax:660-726-3366
Practice Address - Street 1:406 N RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MO
Practice Address - Zip Code:64402-2403
Practice Address - Country:US
Practice Address - Phone:816-390-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities