Organization
BEACON HEALTH SYSTEMS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PRINCE EJEMOLE (ADMINISTRATOR)
(478) 457-7706
Entity
Organization
Contact information
Practice address
507 N HOUSTON RD, SUITE D-3, WARNER ROBINS, GA 31093-8828
(478) 845-0881
(478) 845-0858
Mailing address
3898 CRAGGY PERCH, DOUGLASVILLE, GA 30135-8700
(478) 845-0881
(478) 845-0858
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
005-R-1041
GA
Other
Enumeration date
05/14/2012
Last updated
07/17/2013
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