Healthcare Provider Details

I. General information

NPI: 1942144159
Provider Name (Legal Business Name): BELOVED HOUSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21198 BEAUJOLAIS WAY
APPLE VALLEY CA
92308-5843
US

IV. Provider business mailing address

2477 E BENNINGTON ST
ONTARIO CA
91761-3873
US

V. Phone/Fax

Practice location:
  • Phone: 760-285-4188
  • Fax:
Mailing address:
  • Phone: 760-285-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN MCCOY
Title or Position: CEO
Credential:
Phone: 760-285-4188