Healthcare Provider Details

I. General information

NPI: 1508925538
Provider Name (Legal Business Name): BRITTANY RESIDENTIAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 ARCOLA ROAD
MADISON OH
44057-3035
US

IV. Provider business mailing address

3100 ARCOLA ROAD
MADISON OH
44057-3035
US

V. Phone/Fax

Practice location:
  • Phone: 440-428-6648
  • Fax: 440-428-4696
Mailing address:
  • Phone: 440-428-6648
  • Fax: 440-428-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: J JAY FABIAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 440-428-6648