BEACON SPECIALIZED LIVING SERVICES, INC. (NPI# 1790835296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790835296 |
| Entity Type | Organization |
| Organization Name | BEACON SPECIALIZED LIVING SERVICES, INC. |
| Practice Address |
555 Railroad St Bangor MI 49013-1464 |
| Mailing Address |
555 Railroad St P.o. Box 69 Bangor MI 49013-1464 |
| Practice Telephone | 2694278400 |
| Practice Fax Number | 2694276027 |
| Mailing Telephone | 2694278400 |
| Mailing Fax Number | 2694276027 |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2015-03-31 |
| Authorized Official Name | KEN RATZLAFF (PRESIDENT, CEO) |
| Authorized Official Telephone | 2694278400 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 251E00000X | Home Health | Agencies | ||
| N | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities | ||
| N | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities | ||
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
555 RAILROAD ST |
| City | BANGOR |
| State | MI |
| Zip Code | 49013-1464 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932194214 | Shirley E Sanders | Physician Assistant | 555 Railroad St, Bangor, MI 49013-1464 | 2005-09-13 |
| 1215324876 | Beacon Specialized Living Services Inc | Psychiatry & Neurology | 555 Railroad St, Bangor, MI 49013-1464 | 2015-04-22 |
| 1013342195 | Charles David Johns | Registered Nurse | 555 Railroad St, Bangor, MI 49013-1464 | 2013-09-09 |
| 1730428095 | Karla Olds Schupp | Social Worker | 555 Railroad St, Bangor, MI 49013-1464 | 2013-02-06 |
| 1952649840 | Lindsy Barton | Social Worker | 555 Railroad St, Bangor, MI 49013-1464 | 2013-01-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083237051 | Twin Doves I LLC | Community Based Residential Treatment Facility, Mental Illness | 48617 36th Ave., Bangor, MI 49013 | 2020-05-25 |
| 1629252895 | Van Buren Cass District Health Department | Community/Behavioral Health | 803 West Arlington, Bangor Health Center, Bangor, MI 49013 | 2007-12-24 |
| 1245426808 | Karen Lee Replogle | Registered Nurse | 52101 34th Avenue, Bangor, MI 49013 | 2007-09-18 |
| 1518152560 | Virginia Douglas | Registered Nurse | 52101 34 Avenue, Bangor, MI 49013 | 2007-09-12 |
| 1992818835 | Intercare Community Health Network | Clinic/Center | 308 Charles St, Bangor, MI 49013 | 2006-08-16 |
| 1326058512 | Intercare Community Health Network | Clinic/Center | 50 Industrial Park Dr, Bangor, MI 49013 | 2006-08-09 |
| 1962439950 | Michele E Allen | Dentist | 308 Charles Street, Bangor, MI 49013 | 2006-06-27 |
| 1366051898 | Kasie M Broe | Social Worker | 52101 34th Avenue, Bangor, MI 49013 | 2020-07-30 |
| 1255985966 | Audria Gilliland | Registered Nurse | 52101 34th Avenue, Bangor, MI 49013 | 2019-07-31 |
| 1417319476 | Terri Lynn Harbin Ilg | Dental Hygienist | 308 Charles Street, Intercare Community Health Network, Bangor, MI 49013 | 2016-03-28 |
| Find all providers in zip 49013 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245699461 | Creative Options, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1660 Ohio St, Bangor, ME 04401-2215 | 2016-02-16 |
| 1801923206 | Debra Raye Kinney | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 23 Fieldstone Drive, Bangor, ME 04401 | 2007-02-27 |
| 1447484027 | Darlene Marie Kenny | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 21 East St, Bangor, ME 04401-5802 | 2009-05-11 |
| 1902933393 | Jeffrey Raymond Kinney | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 23 Fieldstone Drive, Bangor, ME 04401 | 2007-02-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770199507 | Laura Lisa Gonzalez | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 7134 Blankenship Cir, Davison, MI 48423-2317 | 2020-09-17 |
| 1558984377 | Angel Patient Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12601 E Outer Dr, Detroit, MI 48224-4204 | 2020-05-27 |
| 1659990208 | Lydias House | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 11667 152nd Ave, West Olive, MI 49460-9232 | 2020-04-14 |
| 1124667118 | Alternative Community Living, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2678 S Waverly Hwy, Lansing, MI 48911-6303 | 2019-12-23 |
| 1215579537 | Eden Prairie Residential Care Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 302 Welch Blvd, Flint, MI 48503-1105 | 2019-10-09 |
| 1518428333 | Alternative Adult Residence LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 19163 Woodingham Dr, Detroit, MI 48221-1650 | 2019-03-26 |
| 1245701960 | Teresa Elaine Guzman | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 130 Marvin St, Battle Creek, MI 49017-8040 | 2018-12-06 |
| 1508334764 | Marquette Staffing Agency, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 592 Blemhuber Ave, Marquette, MI 49855-4818 | 2018-11-06 |
| 1912481235 | Adrienne Flowers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 18403 Kentucky St, Detroit, MI 48221-2029 | 2018-09-21 |
| 1417431487 | Helping Hands Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5116 18th Rd, Escanaba, MI 49829-9525 | 2018-09-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.