NPIMap

Organization Active NPI

Beacon Health Ventures, Inc.

  • Respite Care
  • South Bend, IN
National Provider Identifier
1477970374
Registry record updated Feb 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
License
14-012264-1 Issued in IN
Legal business name
BEACON HEALTH VENTURES, INC.
Practice address
3355 Douglas Rd
South Bend, IN 46635-1781
Phone
(574) 273-2273
NPI assigned
Mar 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2017

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

Authorized official

Name
Mr. Gregory M Conrad
Title
President
Phone
(574) 647-8777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Respite Care 385H00000X 14-012264-1 IN Primary

Addresses

Primary practice location

3355 Douglas Rd
South Bend, IN 46635-1781

Mailing address

5155 Verdant St
Elkhart, IN 46516-9315
Phone (574) 295-1111

Other identifiers 1

IdentifierTypeStateIssuer
100263690DOtherINIHCP WAIVER

Other names 1

  • Compassionate Caregivers - ELK Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Memorial Home Care Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1477970374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5155 VERDANT ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169315",
            "telephone_number": "574-295-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 DOUGLAS RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351781",
            "telephone_number": "574-273-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON HEALTH VENTURES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-28",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "CONRAD",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-647-8777",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "IN",
            "license": "14-012264-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHCP WAIVER",
            "identifier": "100263690D",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Compassionate Caregivers - ELK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; 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.