# BEAVER MEDICAL GROUP LP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Other names:** Beaver Medical Group - Highland Extended Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639344716
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (VP OF OPERATIONS)
- **Authorized official phone:** (858) 625-2990

## Contact information

- **Practice address:** 7000 BOULDER AVE, HIGHLAND, CA 92346-3348
- **Practice address phone:** (909) 862-1191
- **Mailing address:** 9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A69210 | CA | Yes |

## Other

- **Enumeration date:** 04/29/2008
- **Last updated:** 06/09/2016