Healthcare Provider Details

I. General information

NPI: 1699837229
Provider Name (Legal Business Name): BERRYMAN HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 GROVE ST
HEALDSBURG CA
95448-4756
US

IV. Provider business mailing address

255 E 400 S SUITE 200
SALT LAKE CITY UT
84111-2846
US

V. Phone/Fax

Practice location:
  • Phone: 707-433-4877
  • Fax: 707-433-5974
Mailing address:
  • Phone: 801-325-0153
  • Fax: 801-596-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number010000014
License Number StateCA

VIII. Authorized Official

Name: MS. FAYE LINCLON
Title or Position: V.P. POLICY AND GOVERNMENT RELATION
Credential:
Phone: 801-325-0153