Provider Demographics
NPI:1417491671
Name:BEVERLY HILLS HOME SERVICES, INC
Entity Type:Organization
Organization Name:BEVERLY HILLS HOME SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAN JUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-457-6005
Mailing Address - Street 1:10601 S. LONGWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643
Mailing Address - Country:US
Mailing Address - Phone:773-474-6265
Mailing Address - Fax:773-941-5366
Practice Address - Street 1:10601 S. LONGWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-474-6265
Practice Address - Fax:773-941-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001377253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3001377OtherIL DEPT. OF PUBLIC HEALTH HOME SERVICES ACCOUNT NUMBER