Provider Demographics
NPI:1700927092
Name:BEACON THERAPEUTIC
Entity Type:Organization
Organization Name:BEACON THERAPEUTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-298-1243
Mailing Address - Street 1:1912 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2625
Mailing Address - Country:US
Mailing Address - Phone:773-298-1243
Mailing Address - Fax:773-298-1078
Practice Address - Street 1:1912 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2625
Practice Address - Country:US
Practice Address - Phone:773-298-1243
Practice Address - Fax:773-298-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)