Provider Demographics
NPI:1467516450
Name:BEREA HEALTH MINISTRY, INC
Entity Type:Organization
Organization Name:BEREA HEALTH MINISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAPPIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-986-0485
Mailing Address - Street 1:305 ESTILL STREET
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1742
Mailing Address - Country:US
Mailing Address - Phone:859-986-1274
Mailing Address - Fax:859-986-1279
Practice Address - Street 1:305 ESTILL STREET
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1742
Practice Address - Country:US
Practice Address - Phone:859-986-1274
Practice Address - Fax:859-986-1279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEREA HEALTH MINISTRY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QR1300X261QR1300X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001718Medicaid
KY35-001718Medicaid
KY35001718Medicaid