Provider Demographics
NPI:1659607539
Name:THE BERRES HOMES INC
Entity Type:Organization
Organization Name:THE BERRES HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-646-8703
Mailing Address - Street 1:1919 IGLEHART AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5140
Mailing Address - Country:US
Mailing Address - Phone:651-646-8703
Mailing Address - Fax:
Practice Address - Street 1:1919 IGLEHART AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5140
Practice Address - Country:US
Practice Address - Phone:651-646-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191225-4-AFC311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home