Organization
BEACON HUB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IAN MAZIMPAKA (CEO)
(210) 769-1554
Entity
Organization
Contact information
Practice address
2355 STATE ST STE 101, SALEM, OR 97301-4541
(210) 769-1554
Mailing address
10725 SW BARBUR BLVD, PORTLAND, OR 97219-8676
(210) 769-1554
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/08/2023
Last updated
12/08/2023
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