Organization
BERACHAH VALLEY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PHILLIS CREEK BURRESS (OWNER)
(318) 757-9718
Entity
Organization
Contact information
Practice address
1505 MCCREIGHT ST, BASTROP, LA 71220-2454
(318) 757-9718
(318) 757-0144
Mailing address
PO BOX 296, FERRIDAY, LA 71334-0296
(318) 757-9718
(318) 757-0144
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
PCA6676
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1519111
—
LA
Enumeration date
04/03/2007
Last updated
08/22/2020
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