Healthcare Provider Details

I. General information

NPI: 1265660138
Provider Name (Legal Business Name): BRANDY BRACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BACK SEARSPORT RD
SEARSPORT ME
04974-3521
US

IV. Provider business mailing address

33 BACK SEARSPORT RD
SEARSPORT ME
04974-3521
US

V. Phone/Fax

Practice location:
  • Phone: 207-548-2140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRANDY BRACY
Title or Position: OWNER
Credential:
Phone: 207-548-2140