NPIMap

Organization Active NPI

Beacon Specialized Living New Jersey, Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Kalamazoo, MI
National Provider Identifier
1013615269
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
BEACON SPECIALIZED LIVING NEW JERSEY, INC.
Practice address
890 N 10TH St
Kalamazoo, MI 49009-6192
Phone
(269) 427-8400
NPI assigned
Feb 17, 2023
Last updated
Mar 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Darren Hodgdon
Title
Chief Executive Officer
Phone
(269) 427-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

890 N 10TH St
Kalamazoo, MI 49009-6192

Mailing address

890 N 10TH St
Kalamazoo, MI 49009-6192
Phone (269) 427-8400

Other identifiers 1

IdentifierTypeStateIssuer
0450858187MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Beacon Specialized Living New Jersey Inc61 organizations share this tax ID, including this one

Locations

890 N 10th St
Kalamazoo, MI 49009
Phone (269) 427-8400

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677715200000",
    "number": "1013615269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 N 10TH ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490096192",
            "telephone_number": "269-427-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 N 10TH ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490096192",
            "telephone_number": "269-427-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON SPECIALIZED LIVING NEW JERSEY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-17",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A",
        "authorized_official_last_name": "HODGDON",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "269-427-8400"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0450858187",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.