Provider Demographics
NPI:1922375138
Name:BEACON HARBOR HOMES INC.
Entity Type:Organization
Organization Name:BEACON HARBOR HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:A
Authorized Official - Last Name:WETHERELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-792-1888
Mailing Address - Street 1:3689 FASHION SQUARE BLVD.
Mailing Address - Street 2:STE 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603
Mailing Address - Country:US
Mailing Address - Phone:989-792-1888
Mailing Address - Fax:989-792-1851
Practice Address - Street 1:3124 KOCHVILLE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9303
Practice Address - Country:US
Practice Address - Phone:989-792-1888
Practice Address - Fax:989-792-1851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness