Provider Demographics
NPI:1043348857
Name:THE BERRYMAN HOUSE INC
Entity Type:Organization
Organization Name:THE BERRYMAN HOUSE INC
Other - Org Name:BERRYMAN HOUSE GROUP HOME FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:FREELAND
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-282-8492
Mailing Address - Street 1:223 BERRYMAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3221
Mailing Address - Country:US
Mailing Address - Phone:336-282-8492
Mailing Address - Fax:
Practice Address - Street 1:223 BERRYMAN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3221
Practice Address - Country:US
Practice Address - Phone:336-282-8492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC041319320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities