MEDICARE: BEECHWOOD DIVISION

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	240000757	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164558714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEECHWOOD DIVISION

Provider Business Mailing Address
First Line	:	13342 VICTORIA ST
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-2020
Country	:	US
Telephone Number	:	909-899-5046
Fax Number	:	909-463-2005

Provider Business Practice Location Address
First Line	:	7976 BEECHWOOD DR
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-1830
Country	:	US
Telephone Number	:	909-899-5046
Fax Number	:	909-463-2005

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS DEISY ODETT MENDOZA
Credential	:
Telephone Number	:	909-912-9314

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	06/01/2026

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Directions to “BEECHWOOD DIVISION ” Practice Location

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