Provider Demographics
NPI:1124892450
Name:BERNICE GROUP HOMES LLC
Entity type:Organization
Organization Name:BERNICE GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AJIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUNSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-755-8404
Mailing Address - Street 1:317 IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2548
Mailing Address - Country:US
Mailing Address - Phone:973-755-8404
Mailing Address - Fax:
Practice Address - Street 1:317 IRWIN ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2548
Practice Address - Country:US
Practice Address - Phone:973-755-8404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities