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Organization Active NPI

Beacon Health Ventures, Inc.

  • Home Health Agency
  • South Bend, IN
National Provider Identifier
1679509848
Registry record updated Feb 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
06-005298-1 Issued in IN
Legal business name
BEACON HEALTH VENTURES, INC.
Practice address
3355 Douglas Road
South Bend, IN 46635-1780
Phone
(574) 647-2273
NPI assigned
Jun 22, 2006
Last updated
Feb 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2018

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

Authorized official

Name
Sandra L Smigielski
Title
Manager
Phone
(574) 647-8731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 06-005298-1 IN Primary

Addresses

Primary practice location

3355 Douglas Road
South Bend, IN 46635-1780

Mailing address

3355 Douglas Road
South Bend, IN 46635-1780
Phone (574) 647-8731

Other identifiers 2

IdentifierTypeStateIssuer
000000098082OtherINANTHEM - HHA
100091080AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Jul 7, 2018 Change of OwnershipThis provider was the seller Elara CaringCCN 157095, IN, NPI 1013493493

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518739200000",
    "number": "1679509848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 DOUGLAS ROAD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351780",
            "telephone_number": "574-647-8731",
            "fax_number": "574-647-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 DOUGLAS ROAD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351780",
            "telephone_number": "574-647-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON HEALTH VENTURES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2018-02-16",
        "status": "A",
        "authorized_official_last_name": "SMIGIELSKI",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "574-647-8731"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IN",
            "license": "06-005298-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM - HHA",
            "identifier": "000000098082",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100091080A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.