Provider Demographics
NPI:1740934645
Name:BEACON HOME CARE SERVICES, LLC
Entity type:Organization
Organization Name:BEACON HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAFARA
Authorized Official - Middle Name:DOZIER
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:843-382-3052
Mailing Address - Street 1:392 MCCLAM RD
Mailing Address - Street 2:
Mailing Address - City:CADES
Mailing Address - State:SC
Mailing Address - Zip Code:29518-3302
Mailing Address - Country:US
Mailing Address - Phone:843-382-3052
Mailing Address - Fax:843-382-3053
Practice Address - Street 1:392 MCCLAM RD
Practice Address - Street 2:
Practice Address - City:CADES
Practice Address - State:SC
Practice Address - Zip Code:29518-3302
Practice Address - Country:US
Practice Address - Phone:843-382-3052
Practice Address - Fax:843-382-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health