Provider Demographics
NPI:1861560849
Name:BEACON IN-HOME CARE, INC.
Entity type:Organization
Organization Name:BEACON IN-HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIE
Authorized Official - Middle Name:COATS
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-879-8217
Mailing Address - Street 1:110 CROSS STREET
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671-0401
Mailing Address - Country:US
Mailing Address - Phone:828-879-8217
Mailing Address - Fax:828-874-1577
Practice Address - Street 1:110 CROSS STREET
Practice Address - Street 2:
Practice Address - City:RUTHERFORD COLLEGEL
Practice Address - State:NC
Practice Address - Zip Code:28671-0401
Practice Address - Country:US
Practice Address - Phone:828-879-8217
Practice Address - Fax:828-874-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2357251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408251Medicaid