Provider Demographics
NPI:1851613061
Name:BEACON COMPREHENSIVE SERVICES LLC
Entity Type:Organization
Organization Name:BEACON COMPREHENSIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYLET
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-791-0088
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-0209
Mailing Address - Country:US
Mailing Address - Phone:252-791-0088
Mailing Address - Fax:
Practice Address - Street 1:190 LA KEISER DRIVE
Practice Address - Street 2:ROOM B
Practice Address - City:COLUMBIA
Practice Address - State:NC
Practice Address - Zip Code:27925
Practice Address - Country:US
Practice Address - Phone:252-796-5606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health