MEDICARE: BERNARDO TERRESS THE ETERNAL YOUTH HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1225599590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNARDO TERRESS THE ETERNAL YOUTH HOME

Provider Business Mailing Address
First Line	:	2218 MERMAID DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-3621
Country	:	US
Telephone Number	:	915-249-6079
Fax Number	:	915-633-1994

Provider Business Practice Location Address
First Line	:	2218 MERMAID DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-3621
Country	:	US
Telephone Number	:	915-249-6079
Fax Number	:	915-633-1994

Authorized Official
Title or Position	:	OWNER
Name	:	BERNARDO TERRES
Credential	:	OWNER
Telephone Number	:	915-249-6079

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	03/28/2019

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