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General NPI Number Information
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NPI Number | 1548044696
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Entity Type | Organization
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Legal Business Name | BEREA COMMUNITY HEALTHCARE, LLC
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 601 SULPHUR SPRINGS RD
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City | GREENVILLE
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State | SC
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Zip | 29617-1621
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Country | US
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Telephone | 864-900-4913
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Fax |
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Provider Business Mailing Address
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Address Line | 262 N UNIVERSITY AVE
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City | FARMINGTON
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State | UT
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Zip | 84025-2975
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | JOHN MITCHELL
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Credential |
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Telephone | 385-988-3319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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