Provider Demographics
NPI:1811461734
Name:BEAUMONT ASHN, LLC
Entity type:Organization
Organization Name:BEAUMONT ASHN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP LEGAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOPSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-299-1111
Mailing Address - Street 1:C/O ALTERNATE SOLUTIONS HEALTH NETWORK
Mailing Address - Street 2:1050 FORRER BLVD
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420
Mailing Address - Country:US
Mailing Address - Phone:937-395-3023
Mailing Address - Fax:937-853-0552
Practice Address - Street 1:1975 TECHNOLOGY DR STE B
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4247
Practice Address - Country:US
Practice Address - Phone:248-743-9500
Practice Address - Fax:248-636-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1563088Medicaid
MI2592813Medicaid