Organization
BEACON SPECIALIZED LIVING WISCONSIN INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LONGO (EXECUTIVE VICE PRESIDENT OF OPERATI)
(630) 258-8638
Entity
Organization
Contact information
Practice address
703 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1647
(262) 235-4130
Mailing address
520 N POWERS ST, PORT WASHINGTON, WI 53074-1632
(262) 261-5262
(262) 268-0775
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
06/27/2024
Last updated
06/27/2024
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