Beach Club Residential Living Inc

Primary specialty

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

License

2056975 Issued in OH

Legal business name

BEACH CLUB RESIDENTIAL LIVING INC

Practice address

5254 Lake Rd E
Suite #3
Geneva, OH 44041-9490

Phone

(440) 466-0988

Fax

(440) 466-0315

NPI assigned

Apr 12, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Luann Kay Busch

Title

Owner

Phone

(440) 466-0988

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740404870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5254 LAKE RD E",
            "address_2": "SUITE #3",
            "city": "GENEVA",
            "state": "OH",
            "postal_code": "440419490",
            "telephone_number": "440-466-0988",
            "fax_number": "440-466-0315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5254 LAKE RD E",
            "address_2": "SUITE #3",
            "city": "GENEVA",
            "state": "OH",
            "postal_code": "440419490",
            "telephone_number": "440-466-0988",
            "fax_number": "440-466-0315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH CLUB RESIDENTIAL LIVING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUSCH",
        "authorized_official_first_name": "LUANN",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-466-0988",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "2056975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTRACT NUMBER",
            "identifier": "0400355",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2056975",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Baron, MD
• Jennifer Baroni, PT
• Darlene A Barron, DO
• Gina Marie Basich, MS, RDN, LD
• Colleen Bates, PMHNP
• Beacon Orthopaedics & Sports Medicine, LTD (Precision Orthopaedic Specialties, Inc DBA OrthoAlliance of Ohio)
• Brenda Sue Beck, D.O.
• Lauren Beck
• William Berk, MD
• William H Blatt Jr., D.M.D.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Geneva, OH
• Providers in Geneva, OH by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.