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General NPI Number Information
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NPI Number | 1225725344
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Entity Type | Organization
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Legal Business Name | BRANLO ENTERPRISES, LLC
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 210 MORRIS ST
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City | LA CONNER
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State | WA
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Zip | 98257-7037
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Country | US
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Telephone | 360-305-9716
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Fax |
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Provider Business Mailing Address
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Address Line | 1286 THALEN DR
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City | LYNDEN
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State | WA
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Zip | 98264-9314
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Country | US
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Telephone | 360-319-1980
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ ADMINISTRATOR
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Name | BRANDY VANDEKOP
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Credential | MBA
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Telephone | 360-319-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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