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	:	1912863895
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	:	760-285-4188
Fax Number	:

Provider Business Practice Location Address
First Line	:	21198 BEAUJOLAIS WAY
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5843
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	:	01/05/2026
Last Update Date	:	01/05/2026

Similar Medicare Providers

1891567939 — SIR DUPLECHAN
Practice Location Address:

21198 BEAUJOLAIS WAY
APPLE VALLEY, CA
92308-5843

Practice Phone: 661-728-6292
Practice Fax:

1225073588 — VALLEY ASSOCIATED UROLOGY MEDICARE GROUP INC
Practice Location Address:

200 COTTAGE AVE , STE 101
MANTECA, CA
95336-4935

Practice Phone: 209-239-2197
Practice Fax: 209-239-7672

1023080777 — KING COUNTY FIRE PROTECTION DISTRICT 43
Practice Location Address:

23775 SE 264TH ST
MAPLE VALLEY, WA
98038-5843

Practice Phone: 425-432-0200
Practice Fax:

1982078978 — VALLEY STREAM PHARMACY INC
Practice Location Address:

238 ROCKAWAY AVE STE A
VALLEY STREAM, NY
11580-5843

Practice Phone: 516-442-0200
Practice Fax: 516-442-0306

1922646728 — EDUHEALTH PERSONAL CARE SERVICES
Practice Location Address:

5843 EAGLE VALLEY DR SAINT LOUIS MO 63136
SAINT LOUIS, MO
63136

Practice Phone: 314-371-7717
Practice Fax:

1558105429 — VALLEY STREAM PHARMACY INC
Practice Location Address:

238 ROCKAWAY AVE STE A
VALLEY STREAM, NY
11580-5843

Practice Phone: 516-442-0200
Practice Fax: 516-442-0306

Directions to “BELOVED HOUSING LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.