Provider Demographics
NPI:1518124205
Name:BERKS BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:BERKS BEHAVIORAL HEALTH, LLC
Other - Org Name:THE BERKSHIRE PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-955-3990
Mailing Address - Street 1:3215 CATHEDRAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 N 6TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3096
Practice Address - Country:US
Practice Address - Phone:610-378-2365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
PA220580261QM0801X
PA220610261QM0801X
PA220620283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102249372-0003OtherMEDICAID PHYSICIAN GROUP
131695OtherMEDICARE PART B PTAN
PA102249372-0002OtherMEDICAID OUTPATIENT PSYCHIATRIC CLINIC
PA102249372-0001OtherMEDICAID PARTIAL PSYCHIATRIC HOSPITAL
PA102249372-0004OtherMEDICAID INPATIENT PSYCHIATRIC HOSPITAL
394052OtherMEDICARE PART A PTAN