| Beacon Hub Llc | |
|
2355 State St Ste 101 Salem OR 97301-4541 | |
| (210) 769-1554 | |
| Not Available |
| Full Name | Beacon Hub Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2355 State St Ste 101, Salem, Oregon |
| Authorized Official Name and Position | Ian Mazimpaka (CEO) |
| Authorized Official Contact | 2107691554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Hub Llc 10725 Sw Barbur Blvd Portland OR 97219-8676 Ph: (210) 769-1554 | Beacon Hub Llc 2355 State St Ste 101 Salem OR 97301-4541 Ph: (210) 769-1554 |
| NPI Number | 1508633694 |
|---|---|
| Provider Enumeration Date | 12/08/2023 |
| Last Update Date | 12/08/2023 |
| Certification Date | 12/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508633694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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