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General NPI Number Information
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NPI Number | 1972123230
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Entity Type | Organization
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Legal Business Name | BERHE GROUP HOME INC.
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 9034 CHANTRY AVE
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City | FONTANA
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State | CA
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Zip | 92335-4613
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Country | US
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Telephone | 909-357-7449
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Fax | 909-887-0160
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Provider Business Mailing Address
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Address Line | 9034 CHANTRY AVE
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City | FONTANA
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State | CA
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Zip | 92335-4613
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Country | US
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Telephone | 909-357-7449
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Fax | 909-887-0160
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Authorized Official
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Title or Position | OFFICE ASSISTANT
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Name | SHAUNICE RENEE COX
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Credential |
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Telephone | 909-713-2016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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