Healthcare Provider Details

I. General information

NPI: 1336074343
Provider Name (Legal Business Name): BERUCHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15004 OLYMPIC LOOP E
BONNEY LAKE WA
98391-8377
US

IV. Provider business mailing address

15004 OLYMPIC LOOP E
BONNEY LAKE WA
98391-8377
US

V. Phone/Fax

Practice location:
  • Phone: 253-440-1818
  • Fax:
Mailing address:
  • Phone: 253-440-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: AUTUMN NUMO
Title or Position: PRESIDENT
Credential:
Phone: 253-440-1818