MEDICARE: BEVERLY HILLS HOME INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1023797222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HILLS HOME INC.

Provider Business Mailing Address
First Line	:	450 S LA PEER DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3504
Country	:	US
Telephone Number	:	310-709-7355
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 S LA PEER DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3504
Country	:	US
Telephone Number	:	310-709-7355
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAHROUS GHODSIAN
Credential	:	MD
Telephone Number	:	310-709-7355

Provider Enumeration Date	:	07/14/2023
Last Update Date	:	07/14/2023

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Directions to “BEVERLY HILLS HOME INC. ” Practice Location

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