Provider Demographics
NPI: | 1639299274 |
---|---|
Name: | BERRY FAMILY SERVICES |
Entity Type: | Organization |
Organization Name: | BERRY FAMILY SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SR. EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | CINDY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BERRY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-412-4707 |
Mailing Address - Street 1: | 5700 ROWLETT RD |
Mailing Address - Street 2: | STE 110 |
Mailing Address - City: | ROWLETT |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75089-7922 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-412-4707 |
Mailing Address - Fax: | 972-202-0314 |
Practice Address - Street 1: | 5700 ROWLETT RD |
Practice Address - Street 2: | STE 110 |
Practice Address - City: | ROWLETT |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75089-7922 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-412-4707 |
Practice Address - Fax: | 972-202-0314 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-29 |
Last Update Date: | 2013-04-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251B00000X | Agencies | Case Management |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 1639299274 | Other | CARE |
TX | 1639299274 | Medicaid |