NPIMap

Organization Active NPI

Nettie Mae Berry Foundation LLC

  • Developmentally Disabled Services Day Training Agency
  • Gainesville, FL
National Provider Identifier
1295993665
Registry record updated Jun 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
689678296 Issued in FL
Legal business name
NETTIE MAE BERRY FOUNDATION LLC
Practice address
113 NE 39TH PL
Gainesville, FL 32609-1717
Phone
(352) 376-4653
Fax
(352) 376-5474
NPI assigned
Jun 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2008

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

Authorized official

Name
Ms. Tandra Lamikia Simmons
Title
Owner
Phone
(352) 258-3450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 689678296 FL Primary

Addresses

Primary practice location

113 NE 39TH PL
Gainesville, FL 32609-1717

Mailing address

113 NE 39TH PL
Gainesville, FL 32609-1717
Phone (352) 376-4653

Other names 1

  • N.M.B. Foundation LLC Other name

National Provider Directory

National Provider Directory
Tax ID family
Nettie Mae Berry Foundation LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1212278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212278400000",
    "number": "1295993665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 NE 39TH PL",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326091717",
            "telephone_number": "352-376-4653",
            "fax_number": "352-376-5474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 NE 39TH PL",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326091717",
            "telephone_number": "352-376-4653",
            "fax_number": "352-376-5474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NETTIE MAE BERRY FOUNDATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-01",
        "last_updated": "2008-06-01",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "TANDRA",
        "authorized_official_middle_name": "LAMIKIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-258-3450",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "FL",
            "license": "689678296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N.M.B. Foundation LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gainesville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2008; 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.