Provider Demographics
NPI:1871542100
Name:BEACON HOME CARE, LLC
Entity type:Organization
Organization Name:BEACON HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HIBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:810-966-3480
Mailing Address - Street 1:415 QUAY ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3829
Mailing Address - Country:US
Mailing Address - Phone:810-966-3480
Mailing Address - Fax:810-966-3483
Practice Address - Street 1:415 QUAY ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3829
Practice Address - Country:US
Practice Address - Phone:810-966-3480
Practice Address - Fax:810-966-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4088483Medicaid
MI4088483Medicaid