Beacon Specialized Living Services, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

BEACON SPECIALIZED LIVING SERVICES, INC.

Practice address

555 Railroad St
Bangor, MI 49013-1464

Phone

(269) 427-8400

Fax

(269) 427-6027

NPI assigned

Jan 10, 2007

Organization subpart

No

Name

Ken Ratzlaff

Title

President, Ceo

Phone

(269) 427-8400

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 31, 2015.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427760000000",
    "number": "1790835296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 RAILROAD ST",
            "address_2": "P.O. BOX 69",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "490131464",
            "telephone_number": "269-427-8400",
            "fax_number": "269-427-6027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 RAILROAD ST",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "490131464",
            "telephone_number": "269-427-8400",
            "fax_number": "269-427-6027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON SPECIALIZED LIVING SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2015-03-31",
        "status": "A",
        "authorized_official_last_name": "RATZLAFF",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "269-427-8400"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele E Allen, DDS
• Bangor Health Center
• Lindsy Barton, LMSW
• Beacon Specialized Living Services Inc
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• Jordan Bills, RN
• Kasie M Broe, LMSW
• Bronson Lakeview Hospital

• All providers in Bangor, MI
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.