Provider Demographics
NPI:1851865786
Name:BEAUMONT ASHN, LLC
Entity Type:Organization
Organization Name:BEAUMONT ASHN, LLC
Other - Org Name:BEAUMONT HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP LEGAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-299-1111
Mailing Address - Street 1:1050 FORRER BLVD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1472
Mailing Address - Country:US
Mailing Address - Phone:937-299-1111
Mailing Address - Fax:
Practice Address - Street 1:1975 TECHNOLOGY DR # J120
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4247
Practice Address - Country:US
Practice Address - Phone:248-743-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1563088Medicaid