Provider Demographics
NPI:1932730140
Name:ALTA BEACON, LLC
Entity Type:Organization
Organization Name:ALTA BEACON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:571-457-4894
Mailing Address - Street 1:7910 ANDRUS RD STE 6
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3171
Mailing Address - Country:US
Mailing Address - Phone:571-457-4894
Mailing Address - Fax:
Practice Address - Street 1:7910 ANDRUS RD STE 6
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3171
Practice Address - Country:US
Practice Address - Phone:571-457-4894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care