Healthcare Provider Details

I. General information

NPI: 1649505629
Provider Name (Legal Business Name): BERRY KARE COMMUNITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 CROOKED BOW CIR
LAS VEGAS NV
89149-6458
US

IV. Provider business mailing address

PO BOX 34768
LAS VEGAS NV
89133-4768
US

V. Phone/Fax

Practice location:
  • Phone: 702-277-9424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMITHA DODSON
Title or Position: MANAGING MEMBER
Credential: BSBM
Phone: 702-277-9424