MEDICARE: BELOVED ONES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1770208662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELOVED ONES

Provider Business Mailing Address
First Line	:	9012 FIR AVE
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2783
Country	:	US
Telephone Number	:	661-434-8759
Fax Number	:

Provider Business Practice Location Address
First Line	:	9012 FIR AVE
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2783
Country	:	US
Telephone Number	:	661-434-8759
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	THANDI SMITH
Credential	:
Telephone Number	:	661-434-8759

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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Directions to “BELOVED ONES ” Practice Location

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