Beacon Specialized Living Services Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

AL110366290 Issued in MI

Legal business name

BEACON SPECIALIZED LIVING SERVICES INC

Doing business as

Beacon Springs

Practice address

6418 Deans Hill Rd
Ste 2
Berrien Center, MI 49102-9750

Phone

(269) 427-8400

NPI assigned

Jul 13, 2015

Last updated

Jul 13, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

BEACON SPECIALIZED LIVING SERVICES INCAs reported in NPPES

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

Authorized official

Name

Gerald Wright

Title

Business Manager

Phone

(269) 427-8400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BEACON SPRINGS Doing business as

Tax ID family

Beacon Specialized Living Services3 organizations share this tax ID, including this one

Part of

Beacon Specialized Living Services

Other organizations with this tax ID 2

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

• Beacon Specialized Living Services

  • Assisted Living Facility (Mental Illness)
  • Gladstone, MI
  • NPI 1639504913
  NPD tax ID
• Beacon Specialized Living Services

  • Assisted Living Facility (Mental Illness)
  • Sebewaing, MI
  • NPI 1790110070
  NPD tax ID

Locations

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436745600000",
    "number": "1518341221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 RAILROAD ST",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "490131464",
            "telephone_number": "269-427-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6418 DEANS HILL RD",
            "address_2": "STE 2",
            "city": "BERRIEN CENTER",
            "state": "MI",
            "postal_code": "491029750",
            "telephone_number": "269-427-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON SPECIALIZED LIVING SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEACON SPECIALIZED LIVING SERVICES INC",
        "enumeration_date": "2015-07-13",
        "last_updated": "2015-07-13",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "269-427-8400"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MI",
            "license": "AL110366290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "AL110366290",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BEACON SPRINGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steven D Agler, DC
• David Michael Arter
• Shandaligwa T Atterberry, LLMSW
• Kimberly Anne Defields Bay, L.L.M.S.W.
• Serika Charles Delfish
• Debora Denise Conley
• Del Fehsenfeld III, LMFT
• Maybetth Patricia Fernandez-Campos
• Jessica Marie Finnegan

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Berrien Center, MI
• Providers in Berrien Center, MI by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2015; 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.