Provider Demographics
NPI:1891414025
Name:BEACON HEALTH, INC
Entity Type:Organization
Organization Name:BEACON HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-241-9480
Mailing Address - Street 1:2750 TAYLOR AVE STE A39
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4474
Mailing Address - Country:US
Mailing Address - Phone:407-676-4068
Mailing Address - Fax:
Practice Address - Street 1:2750 TAYLOR AVE STE A39
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4474
Practice Address - Country:US
Practice Address - Phone:407-676-4068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health