Provider Demographics
NPI:1477031029
Name:BIACON FAMILY AND COMMUNITY SUPPORT SERVICES
Entity type:Organization
Organization Name:BIACON FAMILY AND COMMUNITY SUPPORT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-304-5770
Mailing Address - Street 1:205 PENNFORD PL
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-2407
Mailing Address - Country:US
Mailing Address - Phone:610-485-8959
Mailing Address - Fax:
Practice Address - Street 1:205 PENNFORD PL
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-2407
Practice Address - Country:US
Practice Address - Phone:610-485-8959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103271135-0002OtherMPI