Provider Demographics
NPI:1083371504
Name:BERD DYNASTY LLC
Entity Type:Organization
Organization Name:BERD DYNASTY LLC
Other - Org Name:FRESH START TREATMENT FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-653-1033
Mailing Address - Street 1:3208 N SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-2173
Mailing Address - Country:US
Mailing Address - Phone:317-653-1033
Mailing Address - Fax:317-653-1001
Practice Address - Street 1:3208 N SHERMAN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-2173
Practice Address - Country:US
Practice Address - Phone:317-653-1033
Practice Address - Fax:317-653-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility