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General NPI Number Information
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NPI Number | 1427595867
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Entity Type | Organization
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Legal Business Name | BERSONN LLC
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 934 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5328
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Country | US
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Telephone | 386-252-2627
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Fax | 386-252-4236
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Provider Business Mailing Address
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Address Line | 934 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5328
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Country | US
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Telephone | 386-252-2627
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Fax | 386-252-4236
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MR. WINSTON CUBERO BERNABE
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Credential |
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Telephone | 386-252-2627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL5777
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License Number State | FL
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