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General NPI Number Information
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NPI Number | 1164287330
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Entity Type | Organization
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Legal Business Name | BERK STREET ENTERPRISES LLC
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 2377 GOLD MEADOW WAY STE 275
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City | GOLD RIVER
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State | CA
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Zip | 95670-4405
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Country | US
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Telephone | 916-500-0013
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Fax | 888-745-0922
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Provider Business Mailing Address
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Address Line | 2377 GOLD MEADOW WAY STE 100
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City | GOLD RIVER
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State | CA
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Zip | 95670-4444
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Country | US
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Telephone | 916-201-3551
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Fax | 888-745-0922
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Authorized Official
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Title or Position | OWNER
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Name | JANET LIA PHILLIPS
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Credential | LCSW
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Telephone | 916-201-3551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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