Provider Demographics
NPI:1427595867
Name:BERSONN LLC
Entity type:Organization
Organization Name:BERSONN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:CUBERO
Authorized Official - Last Name:BERNABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-252-2627
Mailing Address - Street 1:934 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5328
Mailing Address - Country:US
Mailing Address - Phone:386-252-2627
Mailing Address - Fax:386-252-4236
Practice Address - Street 1:934 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5328
Practice Address - Country:US
Practice Address - Phone:386-252-2627
Practice Address - Fax:386-252-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5777310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility