Provider Demographics
NPI:1750106332
Name:BEVERLYCARE
Entity type:Organization
Organization Name:BEVERLYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HSIAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-939-1319
Mailing Address - Street 1:433 N 4TH ST STE 205A
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4311
Mailing Address - Country:US
Mailing Address - Phone:909-939-1319
Mailing Address - Fax:
Practice Address - Street 1:433 N 4TH ST STE 205A
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4311
Practice Address - Country:US
Practice Address - Phone:909-939-1319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
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