Provider Demographics
NPI:1972706976
Name:BEAUMONT RETIREMENT COMMUNITY
Entity type:Organization
Organization Name:BEAUMONT RETIREMENT COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:FORTENBAUGH
Authorized Official - Suffix:III
Authorized Official - Credentials:NHA
Authorized Official - Phone:610-526-7000
Mailing Address - Street 1:601 N ITHAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1782
Mailing Address - Country:US
Mailing Address - Phone:610-526-7000
Mailing Address - Fax:610-525-0293
Practice Address - Street 1:601 N ITHAN AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1782
Practice Address - Country:US
Practice Address - Phone:610-526-7000
Practice Address - Fax:610-525-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA194440310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395753Medicare ID - Type Unspecified
PA070404Medicare ID - Type Unspecified