Provider Demographics
NPI:1104022375
Name:VERSAILLES AT CORAL SPRINGS, INC
Entity type:Organization
Organization Name:VERSAILLES AT CORAL SPRINGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAGENE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:954-227-3886
Mailing Address - Street 1:9425 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4102
Mailing Address - Country:US
Mailing Address - Phone:954-227-3886
Mailing Address - Fax:954-227-3003
Practice Address - Street 1:9425 W. SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-227-3886
Practice Address - Fax:954-227-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17661320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities