Bertha's Place, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL060-871 Issued in NC

Legal business name

BERTHA'S PLACE, INC.

Practice address

3412 Green Meadow Dr.
Charlotte, NC 28269-2982

Phone

(704) 598-5106

Fax

(704) 598-5106

NPI assigned

Jan 4, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Wayne Louis Garris

Title

Executive Director

Phone

(704) 598-5106

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063569127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 LOGAN FIELD DR.",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736962",
            "telephone_number": "704-243-4771",
            "fax_number": "704-243-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3412 GREEN MEADOW DR.",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282692982",
            "telephone_number": "704-598-5106",
            "fax_number": "704-598-5106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERTHA'S PLACE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GARRIS",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-598-5106",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL060-871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603939",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madelon Sydney Berryhill, MS
• Keith T Bersch, P.A.C.
• Ellen Bertanzetti, LCMHC
• Norman H Bertels III, MD
• Lindsey Maurer Bertges, PHARMD
• Therese G. Bertolette, NP
• Blake Lee Bertolino
• Kiara Bertolino
• Paul G Bertolotti Jr., PTA
• Colleen Briana Bertoni, MD

• Emotionally Disturbed Childrens' Residential Treatment Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.