Active NPI
Beacon in Home Health LLC
- Home Health Agency
- Yulee, FL
National Provider Identifier
1710564844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- BEACON IN HOME HEALTH LLC
- Practice address
- 57 Homegrown Way Unit 603
Yulee, FL 32097-0180 - Phone
- (904) 867-8900
- Fax
- (904) 551-5017
- NPI assigned
- Mar 25, 2021
- Last updated
- Jan 2, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Graham A Wood
- Title
- Owner
- Phone
- (608) 515-0183
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | NU | Primary |
Addresses
Primary practice location
57 Homegrown Way Unit 603
Yulee, FL 32097-0180
Mailing address
57 Homegrown Way Unit 603
Yulee, FL 32097-0180
Phone (904) 867-8900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221227000342 | FL | Part A Provider - Home Health Agency | 8729486485 | Practice locations: Yulee, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1710564844. Details of each certification follow.
Home health agency certification: CCN 687184
- Legal name
- BEACON IN HOME HEALTH LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jun 3, 2022
- Last certification
- May 25, 2022
- Organization structure
- LLC
- Incorporated
- Nov 30, 2020 in FL
- Enrollment address
- 57 Homegrown Way
Unit 603
Yulee, FL 32097-0180
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Beacon in Home Health LLC
- Overall star rating
- Ownership
- -
- Certified
- Jun 3, 2022
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
4237 Salisbury Rd
Ste 205
Jacksonville, FL 32216
Phone (904) 867-8900
4237 Salisbury Rd
Ste 320
Jacksonville, FL 32216
57 Homegrown Way
Unit 603
Yulee, FL 32097
Phone (904) 867-8900
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Christopher Hughes | 5% Or Greater Direct Ownership Interest | Nov 30, 2020 | 50% |
| Corporate Director | Nov 30, 2020 | 50% | |
| W-2 Managing Employee | Nov 30, 2020 | 50% | |
| Operational/Managerial Control | Nov 30, 2020 | ||
| Graham Wood | 5% Or Greater Direct Ownership Interest | Nov 30, 2021 | 50% |
| Corporate Director | Nov 30, 2021 | ||
| Operational/Managerial Control | Nov 30, 2021 |
Practitioners & affiliated clinicians
Affiliated clinicians 5
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Medicine Physician
- Jacksonville, FL
- NPI 1750545489
Home health agency
-
- Family Medicine Physician
- Jacksonville, FL
- NPI 1356015192
Home health agency
-
- Family Medicine Physician
- Jacksonville, FL
- NPI 1225359557
Home health agency
-
- Adult Health Nurse Practitioner
- Jacksonville, FL
- NPI 1053093138
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616630400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1704153600000",
"number": "1710564844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "57 HOMEGROWN WAY UNIT 603",
"city": "YULEE",
"state": "FL",
"postal_code": "320970180",
"telephone_number": "904-867-8900",
"fax_number": "904-551-5017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "57 HOMEGROWN WAY UNIT 603",
"city": "YULEE",
"state": "FL",
"postal_code": "320970180",
"telephone_number": "904-867-8900",
"fax_number": "904-551-5017"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BEACON IN HOME HEALTH LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-03-25",
"last_updated": "2024-01-02",
"certification_date": "2024-01-02",
"status": "A",
"authorized_official_last_name": "WOOD",
"authorized_official_first_name": "GRAHAM",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "608-515-0183"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yulee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.