Organization
BEACON HEALTH VENTURES INC
Active
Organization
BEACON HEALTH VENTURES INC
Active
Other names
Beacon HC Pharmacy ELK
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY CONRAD (PRESIDENT)
(574) 647-8777
Entity
Organization
Contact information
Practice address
5155 VERDANT ST, ELKHART, IN 46516-9315
(574) 524-7582
(574) 524-7597
Mailing address
3355 DOUGLAS RD, SUITE 100, SOUTH BEND, IN 46635-1781
(574) 647-8731
(574) 647-8768
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100301140C
—
IN
01
—
2158807
PK
—
Enumeration date
06/19/2012
Last updated
02/27/2017
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