Provider Demographics
NPI:1437535309
Name:BEVERLY HILLS HOME CARE
Entity Type:Organization
Organization Name:BEVERLY HILLS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF EXECUTIVE DIRECTOR
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:PO BOX 437746
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-7746
Mailing Address - Country:US
Mailing Address - Phone:773-457-6005
Mailing Address - Fax:
Practice Address - Street 1:10657 S LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2616
Practice Address - Country:US
Practice Address - Phone:773-457-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0530320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities