Organization
BEROS ENTERPRISE LLC
Active
Parent organization
BEROS ENTERPRISE LLC
Other names
Ebenezer House
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEROS ENTERPRISE LLC
Authorized official
MRS. BEVERLIE ROSE GRIZZLE DIRECT OWNER (HABTECHICAN)
(336) 491-7190
Entity
Organization
Contact information
Practice address
5331 STIGALL RD, KERNERSVILLE, NC 27284-7673
(336) 491-7190
(336) 510-7490
Mailing address
5331 STIGALL RD, KERNERSVILLE, NC 27284-7673
(336) 491-7190
(336) 510-7490
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-034-218
NC
Other
Enumeration date
11/05/2007
Last updated
08/25/2009
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