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General NPI Number Information
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NPI Number | 1811712987
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Entity Type | Organization
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Legal Business Name | BEVERELY PLACE LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 5763 DE BACA CT NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-5213
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Country | US
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Telephone | 609-457-4506
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Fax |
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Provider Business Mailing Address
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Address Line | 5763 DE BACA CT NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-5213
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Country | US
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Telephone | 505-395-8682
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BAZE BROWNELL
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Credential | RN
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Telephone | 877-963-2123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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