Healthcare Provider Details

I. General information

NPI: 1548980725
Provider Name (Legal Business Name): BRANCH INTERNATIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 S 16TH ST
PHOENIX AZ
85040-2327
US

IV. Provider business mailing address

PO BOX 32181
PHOENIX AZ
85064-2181
US

V. Phone/Fax

Practice location:
  • Phone: 602-621-7571
  • Fax:
Mailing address:
  • Phone: 520-955-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BILLIE BRANCH
Title or Position: PRESIDENT
Credential:
Phone: 520-955-8151