MEDICARE: DARBRE HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1881249662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARBRE HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	3744 STONEWALL MANOR DR
Second Line	:
City	:	TRIANGLE
State	:	VA
Zip	:	22172-1400
Country	:	US
Telephone Number	:	571-276-7099
Fax Number	:

Provider Business Practice Location Address
First Line	:	3744 STONEWALL MANOR DR
Second Line	:
City	:	TRIANGLE
State	:	VA
Zip	:	22172-1400
Country	:	US
Telephone Number	:	571-276-7099
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SUSAN DARBRE
Credential	:
Telephone Number	:	571-276-7099

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	08/07/2019

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