Provider Demographics
NPI:1760936884
Name:BEVERLYCARE
Entity Type:Organization
Organization Name:BEVERLYCARE
Other - Org Name:BEVERLYCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORALI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAMATSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-725-5073
Mailing Address - Street 1:101 E BEVERLY BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4316
Mailing Address - Country:US
Mailing Address - Phone:323-726-1400
Mailing Address - Fax:
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4300
Practice Address - Country:US
Practice Address - Phone:323-837-5147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health