Healthcare Provider Details

I. General information

NPI: 1366219313
Provider Name (Legal Business Name): BERNICE'S ROOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 N NEW BRAUNFELS AVE STE 103
SAN ANTONIO TX
78202-2429
US

IV. Provider business mailing address

734 N NEW BRAUNFELS AVE STE 103
SAN ANTONIO TX
78202-2429
US

V. Phone/Fax

Practice location:
  • Phone: 210-904-1164
  • Fax:
Mailing address:
  • Phone: 210-904-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MISS TRACI ALLEN
Title or Position: CEO
Credential: RN
Phone: 210-452-7046