Beaconway Isl I, LLC

Primary specialty

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

Legal business name

BEACONWAY ISL I, LLC

Practice address

2606 Villa CT
Marshall, MO 65340-9711

Phone

(660) 229-0175

Fax

(660) 831-1189

NPI assigned

Feb 11, 2008

Organization subpart

No

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

Authorized official

Name

Ben Rogers

Title

President

Phone

(660) 726-3415

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203984000000",
    "number": "1982872149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606 VILLA CT",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653409711",
            "telephone_number": "660-229-0175",
            "fax_number": "660-831-1189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2606 VILLA CT",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653409711",
            "telephone_number": "660-229-0175",
            "fax_number": "660-831-1189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACONWAY ISL I, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-11",
        "last_updated": "2008-02-26",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "660-726-3415"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Suzanne Baker, MED, LPC
• Matteo Barausse
• Batlin Recovery Center-Marshall LLC
• BDM Associates LLC
• Beaconway III, LLC
• Laura Renee Beasley, CCC-SLP
• Lauren Ruth Becker, PHARMD
• Jake Bellon, MS, LAT, ATC
• Adrienne Leigh Beumer
• Keith Bishop

• All providers in Marshall, MO
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; 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.