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NPI Code Detail

MEDICARE: BEREA OPERATIONS, LLC

MEDICARE: BEREA OPERATIONS, LLC
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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1760934392
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEREA OPERATIONS, LLC
Provider Business Mailing Address
First Line : 300 PROVIDER CT
Second Line :
City : RICHMOND
State : KY
Zip : 40475-8488
Country : US
Telephone Number : 859-623-0898
Fax Number :
Provider Business Practice Location Address
First Line : 1043 BROOKLYN BLVD
Second Line :
City : BEREA
State : KY
Zip : 40403-1090
Country : US
Telephone Number : 859-626-8106
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : BENJAMIN LANDA
Credential :
Telephone Number : 516-869-3700
Provider Enumeration Date : 10/31/2016
Last Update Date : 06/16/2017

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Directions to “BEREA OPERATIONS, LLC ” Practice Location

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