Healthcare Provider Details

I. General information

NPI: 1457167546
Provider Name (Legal Business Name): BEETON KER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LAKES DR STE 225
WEST COVINA CA
91790-2910
US

IV. Provider business mailing address

1050 LAKES DR STE 225
WEST COVINA CA
91790-2910
US

V. Phone/Fax

Practice location:
  • Phone: 626-608-1913
  • Fax: 626-608-6436
Mailing address:
  • Phone: 626-608-1913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. REANNE BEETON
Title or Position: PRESIDENT
Credential:
Phone: 626-482-4456