MEDICARE: BELOVED HOUSING, LLC

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1215529201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELOVED HOUSING, LLC

Provider Business Mailing Address
First Line	:	2477 E BENNINGTON ST
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-3873
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20923 CAYUGA RD
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-6407
Country	:	US
Telephone Number	:	760-285-4188
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	COLLEEN MCCOY
Credential	:
Telephone Number	:	760-285-4188

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	08/04/2025

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Directions to “BELOVED HOUSING, LLC ” Practice Location

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