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Organization
BEACON SPECIALIZED LIVING MINNESOTA, INC.
Active
Organization
BEACON SPECIALIZED LIVING MINNESOTA, INC.
Active
Other names
Owakihi, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENE HERNANDEZ (REVENUE CYCLE DIRECTOR)
(608) 982-9762
Entity
Organization
Contact information
Practice address
1355 MENDOTA HEIGHTS ROAD, SUITE 260, MENDOTA HEIGHTS, MN 55120
(651) 451-2889
(651) 451-5955
Mailing address
1355 MENDOTA HEIGHTS RD STE 260, MENDOTA HEIGHTS, MN 55120-1168
(651) 451-2889
(651) 451-5955
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
LP2482
MN
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
310400000X
Assisted Living Facility
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
311Z00000X
Custodial Care Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108343100
—
MN
05
—
196680400
—
MN
05
—
211817300
—
MN
01
—
246318
MEDICAID
MN
05
—
24G272
—
MN
05
—
339343700
—
MN
05
—
392150600
—
MN
05
—
579133200
—
MN
05
—
706520500
—
MN
Enumeration date
08/22/2006
Last updated
08/18/2026
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