Beros Enterprise LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL-034-218 Issued in NC

Legal business name

BEROS ENTERPRISE LLC

Doing business as

Ebenezer House

Practice address

5331 Stigall Rd
Kernersville, NC 27284-7673

Phone

(336) 491-7190

Fax

(336) 510-7490

NPI assigned

Nov 5, 2007

Organization subpart

Yes

Parent organization

BEROS ENTERPRISE LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Beverlie Rose Grizzle, DIRECT OWNER

Title

Habtechican

Phone

(336) 491-7190

Specialties & licenses 1

Addresses

Other names 1

• Ebenezer House Doing business as

Part of

Beros Enterprise LLC

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251158400000",
    "number": "1578743795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5331 STIGALL RD",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847673",
            "telephone_number": "336-491-7190",
            "fax_number": "336-510-7490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5331 STIGALL RD",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847673",
            "telephone_number": "336-491-7190",
            "fax_number": "336-510-7490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEROS ENTERPRISE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEROS ENTERPRISE LLC",
        "enumeration_date": "2007-11-05",
        "last_updated": "2009-08-25",
        "status": "A",
        "authorized_official_last_name": "GRIZZLE",
        "authorized_official_first_name": "BEVERLIE",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "HABTECHICAN",
        "authorized_official_telephone_number": "336-491-7190",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DIRECT OWNER"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-034-218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ebenezer House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Kernersville, NC
• Providers in Kernersville, 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 25, 2009; 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.