Provider Demographics
NPI:1053318501
Name:COUNTY OF BERKS OFFICE OF THE CONTROLLER
Entity Type:Organization
Organization Name:COUNTY OF BERKS OFFICE OF THE CONTROLLER
Other - Org Name:BERKS HEIM NURSING & REHABILIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-376-4841
Mailing Address - Street 1:1011 BERK RD
Mailing Address - Street 2:BUSINESS OFFICE
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8705
Mailing Address - Country:US
Mailing Address - Phone:610-376-4841
Mailing Address - Fax:610-376-9828
Practice Address - Street 1:1011 BERK RD
Practice Address - Street 2:BUSINESS OFFICE
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8705
Practice Address - Country:US
Practice Address - Phone:610-376-4841
Practice Address - Fax:610-376-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005763100001Medicaid
PA0005763100001Medicaid