NPIMap

Organization Active NPI

Beacon Specialized Living Ohio Inc

Doing business as Beacon Specialized Living

  • Intellectual Disabilities Intermediate Care Facility
  • Dayton, OH
National Provider Identifier
1861272270
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
BEACON SPECIALIZED LIVING OHIO INC
Doing business as
Beacon Specialized Living
Practice address
1125 Green Tree Dr
Dayton, OH 45429-6104
Phone
(614) 330-3073
NPI assigned
Oct 3, 2023
Last updated
Oct 3, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
KEYSTONE COMMUNITY RESOURCES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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

Authorized official

Name
Janet L Pell
Title
VP of Ops/Biz Dev
Phone
(614) 330-3073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

1125 Green Tree Dr
Dayton, OH 45429-6104

Mailing address

967 Worthington Woods Loop Rd Ste 110
Worthington, OH 43085-5743
Phone (614) 330-3073

Other names 1

  • Beacon Specialized Living Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861272270. Details of each certification follow.

  • CCN 36G782 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G782

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BEACON GREEN TREE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 3, 2024
Last certification
Jun 23, 2025
Beds
4
Ownership / control type
Private (proprietary)
Facility address
1125 Green Tree Drive
Dayton, OH 45429

National Provider Directory

National Provider Directory
Tax ID family
Beacon Specialized Living5 organizations share this tax ID, including this one
Part of
Keystone Community Resources Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

967 Worthington Woods Loop Rd
Ste 110
Worthington, OH 43085

NPI Registry JSON

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

{
    "created_epoch": "1696291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1861272270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 WORTHINGTON WOODS LOOP RD STE 110",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430855743",
            "telephone_number": "614-330-3073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 GREEN TREE DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454296104",
            "telephone_number": "614-330-3073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON SPECIALIZED LIVING OHIO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEYSTONE COMMUNITY RESOURCES, INC.",
        "enumeration_date": "2023-10-03",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "PELL",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP OF OPS/BIZ DEV",
        "authorized_official_telephone_number": "614-330-3073"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Specialized Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.