Organization
BEACON SPECIALIZED LIVING SERVICES INC
Active
Parent organization
BEACON SPECIALIZED LIVING SERVICES INC
Other names
BEACON SPRINGS
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEACON SPECIALIZED LIVING SERVICES INC
Authorized official
GERALD WRIGHT (BUSINESS MANAGER)
(269) 427-8400
Entity
Organization
Contact information
Practice address
6418 DEANS HILL RD, STE 2, BERRIEN CENTER, MI 49102-9750
(269) 427-8400
Mailing address
555 RAILROAD ST, BANGOR, MI 49013-1464
(269) 427-8400
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
AL110366290
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL110366290
LICENSE
MI
Enumeration date
07/13/2015
Last updated
07/13/2015
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