Provider Demographics
NPI:1902473242
Name:BELOVED COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:BELOVED COMMUNITY CARE LLC
Other - Org Name:BELOVED COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-235-1712
Mailing Address - Street 1:4104 HOUSTON HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4700
Mailing Address - Country:US
Mailing Address - Phone:361-235-1712
Mailing Address - Fax:
Practice Address - Street 1:4104 HOUSTON HWY STE 200
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4700
Practice Address - Country:US
Practice Address - Phone:361-235-1712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care