Healthcare Provider Details

I. General information

NPI: 1346965902
Provider Name (Legal Business Name): BRIAN'S HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 FARMBROOK DR
LEVITTOWN PA
19055-2101
US

IV. Provider business mailing address

757 SPRINGDALE DR
EXTON PA
19341-2829
US

V. Phone/Fax

Practice location:
  • Phone: 215-750-4285
  • Fax:
Mailing address:
  • Phone: 610-399-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LORI PLUNKETT
Title or Position: CEO
Credential:
Phone: 610-399-1175