Basic Information
| Provider Information | |||||||||
| NPI: | 1750453130 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEVERLY'S HOME HEALTH CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12510 QUEENS BLVD STE 5 | ||||||||
| Address2: | |||||||||
| City: | KEW GARDENS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114151522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184595592 | ||||||||
| FaxNumber: | 7184596047 | ||||||||
| Practice Location | |||||||||
| Address1: | 12510 QUEENS BLVD STE 5 | ||||||||
| Address2: | |||||||||
| City: | KEW GARDENS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114151522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184595592 | ||||||||
| FaxNumber: | 7184596047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 01/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | NICHOLS | ||||||||
| AuthorizedOfficialFirstName: | BEVERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7184595592 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 9569L001 | NY | N | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 251J00000X | N | Agencies | Nursing Care | 3747P1801X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Technician | Personal Care Attendant | 374U00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Home Health Aide | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 9569L001 | 01 | NY | HOME HEALTH CARE AGENCY | OTHER | 01761260 | 05 | NY | MEDICAID |