Provider Demographics
NPI:1184628919
Name:BEVERLY COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:BEVERLY COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:BEVERLY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-726-1222
Mailing Address - Street 1:309 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4308
Mailing Address - Country:US
Mailing Address - Phone:323-726-1222
Mailing Address - Fax:323-837-3473
Practice Address - Street 1:309 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4308
Practice Address - Country:US
Practice Address - Phone:323-726-1222
Practice Address - Fax:323-837-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93 0000 389282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC 30 350FMedicaid
CAZZT 30 350FMedicaid
CAZZT 40 350FMedicaid
CAHSP 30 350FMedicaid
CA05-0350Medicare Oscar/Certification