Basic Information
| Provider Information | |||||||||
| NPI: | 1295880904 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEACON RESPIRATORY SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ARCADIA H.O.M.E. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26777 CENTRAL PARK BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480764162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483527530 | ||||||||
| FaxNumber: | 2483525189 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 SAINT AUGUSTINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322172835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043320656 | ||||||||
| FaxNumber: | 9043329404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 09/19/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RILEY | ||||||||
| AuthorizedOfficialFirstName: | ELLYN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 4072060040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ARCADIA PRODUCTS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
No ID Information.