Provider Demographics
NPI:1659736288
Name:BERACHAH, LLC
Entity Type:Organization
Organization Name:BERACHAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YOSHEDA
Authorized Official - Middle Name:WILLETTE
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-877-6882
Mailing Address - Street 1:7311 SERENADE CIR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-5874
Mailing Address - Country:US
Mailing Address - Phone:301-877-6882
Mailing Address - Fax:
Practice Address - Street 1:7311 SERENADE CIR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-5874
Practice Address - Country:US
Practice Address - Phone:301-877-6882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-26
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities