Provider Demographics
NPI:1558233403
Name:BEACON CARE SERVICES, LLC
Entity type:Organization
Organization Name:BEACON CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLIVE
Authorized Official - Middle Name:FUAM
Authorized Official - Last Name:DIOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-960-7179
Mailing Address - Street 1:1806 KELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1806 KELLINGTON CT
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3126
Practice Address - Country:US
Practice Address - Phone:240-960-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-20
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services