Healthcare Provider Details

I. General information

NPI: 1982202271
Provider Name (Legal Business Name): BERKELEY HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 ELDER ST NW
WASHINGTON DC
20012-2323
US

IV. Provider business mailing address

817 ELDER ST NW
WASHINGTON DC
20012-2323
US

V. Phone/Fax

Practice location:
  • Phone: 240-305-2723
  • Fax:
Mailing address:
  • Phone: 240-305-2723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: FRANKLIN HEKIMA JACKSON
Title or Position: OWNER
Credential: MBA, DDA CERT-MARYLA
Phone: 240-305-2723