Healthcare Provider Details

I. General information

NPI: 1144207804
Provider Name (Legal Business Name): BRYNN MARR HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 VILLAGE DR
JACKSONVILLE NC
28546
US

IV. Provider business mailing address

192 VILLAGE DR
JACKSONVILLE NC
28546
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-1400
  • Fax: 910-577-2766
Mailing address:
  • Phone: 910-577-1400
  • Fax: 910-577-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-768-3482