Beaconway Isl I, LLC

NPI #1982872149 in Marshall, Missouri

Provider Information

NPI Number: 1982872149
Entity Type: Organization
Organization Name: Beaconway Isl I, LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Feb 11, 2008
Last Updated: Feb 26, 2008

Practice Location

Address: 2606 VILLA CT
City: Marshall
State: Missouri
ZIP Code: 65340-9711
Phone: (660) 229-0175

Authorized Official

Name: BEN ROGERS
Title: PRESIDENT
Phone: (660) 726-3415

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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