Healthcare Provider Details

I. General information

NPI: 1801167507
Provider Name (Legal Business Name): BRIARWOOD TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY
SPARKS NV
89431-5564
US

IV. Provider business mailing address

18236 SILVERLEAF CT
RENO NV
89508-5047
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-1490
  • Fax:
Mailing address:
  • Phone: 352-538-2143
  • Fax:

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: MRS. PHYLLIS RAK
Title or Position: QMHA
Credential:
Phone: 352-538-2143