# BEACON SPECIALIZED LIVING SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790835296
- **Authorized official:** KEN RATZLAFF (PRESIDENT, CEO)
- **Authorized official phone:** (269) 427-8400

## Contact information

- **Practice address:** 555 RAILROAD ST, BANGOR, MI 49013-1464
- **Practice address phone:** (269) 427-8400
- **Practice address fax:** (269) 427-6027
- **Mailing address:** 555 RAILROAD ST, P.O. BOX 69, BANGOR, MI 49013-1464
- **Mailing address phone:** (269) 427-8400
- **Mailing address fax:** (269) 427-6027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 251E00000X | Home Health Agency | — | NULL | — |
| 310400000X | Assisted Living Facility | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | NULL | — |

## Other

- **Enumeration date:** 01/10/2007
- **Last updated:** 03/31/2015