Provider Demographics
NPI:1578229613
Name:BEACON CHARITIES
Entity type:Organization
Organization Name:BEACON CHARITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-551-0505
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AZ
Mailing Address - Zip Code:85940-0813
Mailing Address - Country:US
Mailing Address - Phone:928-551-0505
Mailing Address - Fax:
Practice Address - Street 1:APACHE COUNTY RD 3398
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AZ
Practice Address - Zip Code:85940
Practice Address - Country:US
Practice Address - Phone:928-551-0505
Practice Address - Fax:928-251-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation