Beacon Specialized Living Wisconsin Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

BEACON SPECIALIZED LIVING WISCONSIN INC.

Practice address

703 N Wisconsin St
Port Washington, WI 53074-1647

Phone

(262) 235-4130

NPI assigned

Jun 27, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Robert Longo

Title

Executive Vice President of Operati

Phone

(630) 258-8638

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1861237349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N POWERS ST",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530741632",
            "telephone_number": "262-261-5262",
            "fax_number": "262-268-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 N WISCONSIN ST",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530741647",
            "telephone_number": "262-235-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON SPECIALIZED LIVING WISCONSIN INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "LONGO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT OF OPERATI",
        "authorized_official_telephone_number": "630-258-8638",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Barber, MS
• Barrett D. Straub DDS, SC
• Deborah Ann Bartlett, REGISTERED NURSE
• Catherine M Bauer
• Lynette Bauer, CADC III
• Martin T Becker, RPH
• Emily Belter, M.S.,CCC-SLP
• Breanne N Beres, DPT, ATC
• Mary Frances Bernadette, MOTR,/LOTR
• Best Self Counseling Center LLP

• Assisted Living Facility (Mental Illness) in Port Washington, WI
• Providers in Port Washington, WI by specialty
• Assisted Living Facility (Mental Illness) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; 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.