MEDICARE: BERRY ASSISTED LIVING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse
2	171W00000X	Contractor

General Provider Information

NPI Number	:	1023630332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERRY ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	2411 CATHERINE ST STE A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-5326
Country	:	US
Telephone Number	:	972-342-8527
Fax Number	:	972-286-8330

Provider Business Practice Location Address
First Line	:	2411 CATHERINE ST STE A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-5326
Country	:	US
Telephone Number	:	972-342-8527
Fax Number	:	972-286-8330

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	JUANA BERRY
Credential	:
Telephone Number	:	972-342-8527

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	06/23/2026

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Directions to “BERRY ASSISTED LIVING LLC ” Practice Location

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