Provider Demographics
NPI:1891112645
Name:BEACON HOMECARE LLC
Entity Type:Organization
Organization Name:BEACON HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WAWERU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-417-2609
Mailing Address - Street 1:500 W CUMMINGS PARK
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6503
Mailing Address - Country:US
Mailing Address - Phone:857-417-2608
Mailing Address - Fax:
Practice Address - Street 1:500 W CUMMINGS PARK
Practice Address - Street 2:SUITE 1300
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6503
Practice Address - Country:US
Practice Address - Phone:857-417-2608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health