Provider Demographics
NPI:1588446785
Name:BEACON ON THE HILL
Entity type:Organization
Organization Name:BEACON ON THE HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-261-2686
Mailing Address - Street 1:3085 N ASHFORD AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-3872
Mailing Address - Country:US
Mailing Address - Phone:909-261-2686
Mailing Address - Fax:
Practice Address - Street 1:4351 LATHAM ST STE 208A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1749
Practice Address - Country:US
Practice Address - Phone:877-547-7694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care