Organization
BEACH CLUB RESIDENTIAL LIVING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUANN KAY BUSCH (OWNER)
(440) 466-0988
Entity
Organization
Contact information
Practice address
5254 LAKE RD E, SUITE #3, GENEVA, OH 44041-9490
(440) 466-0988
(440) 466-0315
Mailing address
5254 LAKE RD E, SUITE #3, GENEVA, OH 44041-9490
(440) 466-0988
(440) 466-0315
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2056975
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0400355
CONTRACT NUMBER
OH
05
—
2056975
—
OH
Enumeration date
04/12/2007
Last updated
08/22/2020
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