Provider Demographics
NPI:1164287330
Name:BERK STREET ENTERPRISES LLC
Entity Type:Organization
Organization Name:BERK STREET ENTERPRISES LLC
Other - Org Name:ZION HEALING GOLD RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LIA
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-201-3551
Mailing Address - Street 1:2377 GOLD MEADOW WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4444
Mailing Address - Country:US
Mailing Address - Phone:916-201-3551
Mailing Address - Fax:888-745-0922
Practice Address - Street 1:2377 GOLD MEADOW WAY STE 275
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4405
Practice Address - Country:US
Practice Address - Phone:916-500-0013
Practice Address - Fax:888-745-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center