Provider Demographics
NPI:1740339530
Name:BEACON HEALTH CARE, LLC
Entity type:Organization
Organization Name:BEACON HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JENISE
Authorized Official - Last Name:CURRY WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-276-4270
Mailing Address - Street 1:PO BOX 28478
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-0478
Mailing Address - Country:US
Mailing Address - Phone:614-276-4270
Mailing Address - Fax:614-485-9175
Practice Address - Street 1:980 SAVANNAH DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3506
Practice Address - Country:US
Practice Address - Phone:614-276-4270
Practice Address - Fax:614-276-4275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2457729Medicaid
OH2457729Medicaid