Provider Demographics
NPI:1831511831
Name:BEACON SOLUTIONS
Entity type:Organization
Organization Name:BEACON SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RUTH BYRD PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-443-3901
Mailing Address - Street 1:22216 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2229
Mailing Address - Country:US
Mailing Address - Phone:586-443-3901
Mailing Address - Fax:
Practice Address - Street 1:22216 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2229
Practice Address - Country:US
Practice Address - Phone:586-443-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========Medicaid