Basic Information
| Provider Information | |||||||||
| NPI: | 1376803098 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DANA A BEECH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 441 SWARTZ CT | ||||||||
| Address2: | |||||||||
| City: | IONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488462157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165236537 | ||||||||
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| Practice Location | |||||||||
| Address1: | 441 SWARTZ CT | ||||||||
| Address2: | |||||||||
| City: | IONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488462157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165236537 | ||||||||
| FaxNumber: | 6165236536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2012 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | BEECH | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6165236537 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801085930 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.