Provider Demographics
NPI:1588412563
Name:BEYOND HEALTHCARE HOLDINGS, LLC
Entity type:Organization
Organization Name:BEYOND HEALTHCARE HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-735-0023
Mailing Address - Street 1:16885 PACIFIC COAST HWY UNIT 1358
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90742-1871
Mailing Address - Country:US
Mailing Address - Phone:949-735-0023
Mailing Address - Fax:
Practice Address - Street 1:16885 PACIFIC COAST HWY UNIT 1358
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:CA
Practice Address - Zip Code:90742-1871
Practice Address - Country:US
Practice Address - Phone:949-735-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)