Provider Demographics
NPI:1144093212
Name:BERNICE BELL HOUSE PERSONAL CARE HOME
Entity type:Organization
Organization Name:BERNICE BELL HOUSE PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CIERA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-938-1528
Mailing Address - Street 1:104 SHARON CIR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-2722
Mailing Address - Country:US
Mailing Address - Phone:229-591-7395
Mailing Address - Fax:
Practice Address - Street 1:104 SHARON CIR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-2722
Practice Address - Country:US
Practice Address - Phone:229-591-7395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home