Provider Demographics
NPI:1023063641
Name:BYRAM HEALTHCARE CENTERS, INC.
Entity type:Organization
Organization Name:BYRAM HEALTHCARE CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERNOCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-302-1600
Mailing Address - Street 1:1925 VAUGHN RD NW
Mailing Address - Street 2:SUITE 115
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4560
Mailing Address - Country:US
Mailing Address - Phone:770-422-5516
Mailing Address - Fax:770-590-8563
Practice Address - Street 1:1925 VAUGHN RD NW
Practice Address - Street 2:SUITE 115
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4560
Practice Address - Country:US
Practice Address - Phone:770-422-5516
Practice Address - Fax:770-590-8563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BYRAM HOLDINGS I, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00761791AMedicaid
TN1508579Medicaid
0228430003Medicare NSC