Provider Demographics
NPI:1588160618
Name:BERNICE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:BERNICE HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:TUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-629-8982
Mailing Address - Street 1:13533 ABRAHAM LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3912
Mailing Address - Country:US
Mailing Address - Phone:512-629-8982
Mailing Address - Fax:
Practice Address - Street 1:14520 BOIS D ARC LN
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3805
Practice Address - Country:US
Practice Address - Phone:512-629-8982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty