Organization
BEACON BRIDGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER PETER YOUSIF (CEO)
(984) 282-6654
Entity
Organization
Contact information
Practice address
415 DUNSTAN AVE STE B, DURHAM, NC 27707-2390
(984) 377-8576
(984) 208-5220
Mailing address
415 DUNSTAN AVE STE B, DURHAM, NC 27707-2390
(833) 496-0445
(984) 208-5220
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHL-032-642
NC DHHS DIVISION OF HEALTH SERVICE REGULATION
NC
Enumeration date
03/07/2024
Last updated
12/08/2024
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