Provider Demographics
NPI:1619487741
Name:BEREA HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BEREA HEALTHCARE, LLC
Other - Org Name:BEREA ACQUISITION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-623-0898
Mailing Address - Street 1:300 PROVIDER CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8488
Mailing Address - Country:US
Mailing Address - Phone:859-623-0898
Mailing Address - Fax:
Practice Address - Street 1:601 RICHMOND RD N
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-8788
Practice Address - Country:US
Practice Address - Phone:859-623-0898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility