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General NPI Number Information
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NPI Number | 1043016538
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Entity Type | Organization
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Legal Business Name | BELOVED HOUSING, LLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 7795 CYPRESS AVE
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City | FONTANA
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State | CA
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Zip | 92336-2596
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Country | US
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Telephone | 760-285-4188
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Fax |
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Provider Business Mailing Address
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Address Line | 2477 E BENNINGTON ST
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City | ONTARIO
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State | CA
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Zip | 91761-3873
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Country | US
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Telephone | 760-285-4188
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. COLLEEN MARIE MCCOY
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Credential | RADT
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Telephone | 760-285-4188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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