Healthcare Provider Details

I. General information

NPI: 1518124205
Provider Name (Legal Business Name): BERKS BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N 6TH ST
READING PA
19601-3096
US

IV. Provider business mailing address

3215 CATHEDRAL AVE NW
WASHINGTON DC
20008-3410
US

V. Phone/Fax

Practice location:
  • Phone: 610-378-2365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number220580
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number220610
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number220620
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GARRY W HOYES
Title or Position: CEO/PRESIDENT
Credential:
Phone: 202-955-3990