Organization
BEACON SPECIALIZED LIVING WISCONSIN INC.
Active
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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