NPIMap

Organization Active NPI

Beacon Specialized Living Ohio Inc

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fairborn, OH
National Provider Identifier
1255010070
Registry record updated Jul 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
BEACON SPECIALIZED LIVING OHIO INC
Practice address
1293 Redbud Dr
Fairborn, OH 45324-5834
Phone
(937) 874-5001
NPI assigned
Jul 18, 2023
Last updated
Jul 18, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
KEYSTONE COMMUNITY RESOURCES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 18, 2023

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

Authorized official

Name
Janet Pell
Title
VP of Ops/Biz Development
Phone
(614) 330-3073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary

Addresses

Primary practice location

1293 Redbud Dr
Fairborn, OH 45324-5834

Mailing address

967 Worthington Woods Loop Rd
Worthington, OH 43085-5743
Phone (614) 330-3073

National Provider Directory

National Provider Directory
Tax ID family
Beacon Specialized Living5 organizations share this tax ID, including this one
Part of
Keystone Community Resources Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1689638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689638400000",
    "number": "1255010070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 WORTHINGTON WOODS LOOP RD",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430855743",
            "telephone_number": "614-330-3073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1293 REDBUD DR",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453245834",
            "telephone_number": "937-874-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON SPECIALIZED LIVING OHIO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEYSTONE COMMUNITY RESOURCES, INC.",
        "enumeration_date": "2023-07-18",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-13",
        "status": "A",
        "authorized_official_last_name": "PELL",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "VP OF OPS/BIZ DEVELOPMENT",
        "authorized_official_telephone_number": "614-330-3073"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairborn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.