Provider Demographics
NPI:1467323121
Name:BEACON BEHAVIORAL HEALTHCARE LLC
Entity type:Organization
Organization Name:BEACON BEHAVIORAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-465-0695
Mailing Address - Street 1:206 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORVEN
Mailing Address - State:NC
Mailing Address - Zip Code:28119-9780
Mailing Address - Country:US
Mailing Address - Phone:704-465-0695
Mailing Address - Fax:704-690-2095
Practice Address - Street 1:206 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORVEN
Practice Address - State:NC
Practice Address - Zip Code:28119-9780
Practice Address - Country:US
Practice Address - Phone:704-465-0695
Practice Address - Fax:704-690-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health