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General NPI Number Information
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NPI Number | 1437535309
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Entity Type | Organization
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Legal Business Name | BEVERLY HILLS HOME CARE
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 10657 S LONGWOOD DR
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City | CHICAGO
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State | IL
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Zip | 60643-2616
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Country | US
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Telephone | 773-457-6005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 437746
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City | CHICAGO
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State | IL
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Zip | 60643-7746
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Country | US
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Telephone | 773-457-6005
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIEF EXECUTIVE DIRECTOR
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Name | MS. ROSELYN A SAN JUAN
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Credential |
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Telephone | 773-457-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 0530
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License Number State | IL
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