Gaven A Bertram

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

AS250414567 Issued in MI

Practice address

2444 Oakridge Dr
Flint, MI 48507-6211

Phone

(810) 766-9377

NPI assigned

Mar 1, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1677628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1740989573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 KENNETH ST",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485292206",
            "telephone_number": "810-766-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2444 OAKRIDGE DR",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485076211",
            "telephone_number": "810-766-9377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTRAM",
        "first_name": "GAVEN",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-01",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": "AS250414567",
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "MI",
            "license": "AS250414567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karolyn F. Berry, RN, MSN, CNS
• Keely Marie Berry
• Lakisha Monique Berry
• Misty Berry
• Samuel Berry III
• Bertram'S Manor LLC
• Bertram'S Manor LLC
• Jennifer Bertuleit, MA, CCC-SLP
• Stephanie Bery
• Best Care Hospice LLC

• Assisted Living Facility (Behavioral Disturbances) in Flint, MI
• Providers in Flint, MI by specialty
• Assisted Living Facility (Behavioral Disturbances) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.