Provider Demographics
NPI:1225599590
Name:BERNARDO TERRESS THE ETERNAL YOUTH HOME
Entity type:Organization
Organization Name:BERNARDO TERRESS THE ETERNAL YOUTH HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRES
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:915-249-6079
Mailing Address - Street 1:2218 MERMAID DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3621
Mailing Address - Country:US
Mailing Address - Phone:915-249-6079
Mailing Address - Fax:915-633-1994
Practice Address - Street 1:2218 MERMAID DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3621
Practice Address - Country:US
Practice Address - Phone:915-249-6079
Practice Address - Fax:915-633-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility