Organization Name: | BEACH CLUB RESIDENTIAL LIVING INC |
NPI Number: | 1740404870 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LUANN KAY BUSCH (OWNER) |
Mailing Address: | 5254 Lake Rd E Suite #3 Geneva |
State: | OH US |
Postal Code: | 440419490 |
Phone Number: | 4404660988 |
Fax Number: | 4404660315 |
NPI Enumeration Date: | 04/12/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 2056975 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |