| NPI | 1629376645 |
|---|---|
| Doing Business As | BEACON MEDICAL GROUP BEHAVIORAL HEALTH SOUTH BEND |
| Entity Type | Organization |
| Authorized Contact | JEFFREY P COSTELLO VP/CFO 574-647-3549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IN 01052982A) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: IN 01052982A) | |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: IN 01052982A) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2024-02-22 |