Provider Demographics
NPI:1609392729
Name:BERHE GROUP HOME, INC.
Entity Type:Organization
Organization Name:BERHE GROUP HOME, INC.
Other - Org Name:THE BERHE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERHE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:909-890-1041
Mailing Address - Street 1:1845 BUSINESS CENTER DR STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3447
Mailing Address - Country:US
Mailing Address - Phone:909-890-1041
Mailing Address - Fax:909-890-1043
Practice Address - Street 1:1604 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1171
Practice Address - Country:US
Practice Address - Phone:909-887-0160
Practice Address - Fax:909-890-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366401098251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health