1598943664 NPI number — BERRY'S RELIABLE RESOURCES L.L.C.

Table of content: (NPI 1598943664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598943664 NPI number — BERRY'S RELIABLE RESOURCES L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERRY'S RELIABLE RESOURCES L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598943664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 HOUMA BLVD
Provider Second Line Business Mailing Address:
STE.400
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-2930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-272-0795
Provider Business Mailing Address Fax Number:
504-304-9242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 HOUMA BLVD
Provider Second Line Business Practice Location Address:
STE.400
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-2930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-272-0795
Provider Business Practice Location Address Fax Number:
504-304-9242
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
BERRY
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
504-272-0795

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  10886 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 2203781938 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1467464 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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