Beacon Hub LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BEACON HUB LLC

Practice address

2355 State St Ste 101
Salem, OR 97301-4541

Phone

(210) 769-1554

NPI assigned

Dec 8, 2023

Organization subpart

No

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

Authorized official

Name

Ian Mazimpaka

Title

Ceo

Phone

(210) 769-1554

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1701993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1508633694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10725 SW BARBUR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972198676",
            "telephone_number": "210-769-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 STATE ST STE 101",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014541",
            "telephone_number": "210-769-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON HUB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-08",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "MAZIMPAKA",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "210-769-1554"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylee Baze, COTA
• Zachary Baze
• Mark Beach
• Richard W Beach, MD
• Nancy Carol Beachy, R.N.
• Beacon of Hope LLC
• Beacon Youth & Prevention Services
• Ryan Beadle, PHARMD
• Laurinda Beagle, RN
• Melissa Lou Beal, MD

• Mental Health Clinic/Center (Including Community Mental Health Center) in Salem, OR
• Providers in Salem, OR by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 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.