Provider Demographics
NPI:1770340382
Name:BEACON SPECIALIZED LIVING MISSOURI INC
Entity type:Organization
Organization Name:BEACON SPECIALIZED LIVING MISSOURI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:TREBBE
Authorized Official - Suffix:III
Authorized Official - Credentials:LCSW
Authorized Official - Phone:417-689-3302
Mailing Address - Street 1:19401 E 40 HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5400
Mailing Address - Country:US
Mailing Address - Phone:417-689-3302
Mailing Address - Fax:
Practice Address - Street 1:19401 E 40 HWY STE 100
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5400
Practice Address - Country:US
Practice Address - Phone:417-689-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities