Provider Demographics
NPI:1396423463
Name:BEACON HOME CARE LLC
Entity type:Organization
Organization Name:BEACON HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:623-377-0825
Mailing Address - Street 1:19590 W SAN MIGUEL AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5422
Mailing Address - Country:US
Mailing Address - Phone:623-377-0825
Mailing Address - Fax:
Practice Address - Street 1:19590 W SAN MIGUEL AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5422
Practice Address - Country:US
Practice Address - Phone:623-377-0825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care