Provider Demographics
NPI:1871301143
Name:LIFE BEACON HEALTHCARE LLC
Entity type:Organization
Organization Name:LIFE BEACON HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MASLAH
Authorized Official - Middle Name:DAKANE
Authorized Official - Last Name:MAALIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-202-3506
Mailing Address - Street 1:320 LINWOOD ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4952
Mailing Address - Country:US
Mailing Address - Phone:614-202-3506
Mailing Address - Fax:
Practice Address - Street 1:320 LINWOOD ST STE 2A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4952
Practice Address - Country:US
Practice Address - Phone:614-202-3506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health