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General NPI Number Information
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NPI Number | 1861128928
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Entity Type | Organization
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Legal Business Name | BEVERLY 811, LLC
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 241 W A ST
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City | DIXON
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State | CA
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Zip | 95620-3448
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Country | US
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Telephone | 707-722-2811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1797
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City | VACAVILLE
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State | CA
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Zip | 95696-1797
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Country | US
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Telephone | 877-796-2811
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MRS. ROSLYN TAGGART
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Credential |
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Telephone | 707-722-2811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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