Healthcare Provider Details

I. General information

NPI: 1760934392
Provider Name (Legal Business Name): BEREA OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 06/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 BROOKLYN BLVD
BEREA KY
40403-1090
US

IV. Provider business mailing address

300 PROVIDER CT
RICHMOND KY
40475-8488
US

V. Phone/Fax

Practice location:
  • Phone: 859-626-8106
  • Fax:
Mailing address:
  • Phone: 859-623-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN LANDA
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-869-3700