Provider Demographics
NPI:1154892081
Name:BETA HOME HEALTH CARE INC
Entity type:Organization
Organization Name:BETA HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-979-2068
Mailing Address - Street 1:705 E VIRGINIA WAY STE D
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3955
Mailing Address - Country:US
Mailing Address - Phone:706-979-2068
Mailing Address - Fax:760-979-2076
Practice Address - Street 1:705 E VIRGINIA WAY STE D
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3955
Practice Address - Country:US
Practice Address - Phone:706-979-2068
Practice Address - Fax:760-979-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1Medicaid