Healthcare Provider Details

I. General information

NPI: 1174292825
Provider Name (Legal Business Name): BERNADINE'S HOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W PLATT ST STE A-104
TAMPA FL
33606-2292
US

IV. Provider business mailing address

301 W PLATT ST STE A-104
TAMPA FL
33606-2292
US

V. Phone/Fax

Practice location:
  • Phone: 510-827-6718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: YEWANDE FINDLEY
Title or Position: OWNER
Credential:
Phone: 510-827-6718