MEDICARE: BEVERLEY'S HOME HEALTHCARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1255930681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLEY'S HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	491 BALTIMORE PIKE APT 630
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-3810
Country	:	US
Telephone Number	:	215-596-5200
Fax Number	:	215-596-5200

Provider Business Practice Location Address
First Line	:	6404 SHORTLEAF PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-8122
Country	:	US
Telephone Number	:	215-596-5200
Fax Number	:	215-596-5200

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANTHONY BEVERLEY
Credential	:
Telephone Number	:	215-596-5200

Provider Enumeration Date	:	10/17/2020
Last Update Date	:	10/17/2020

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