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General NPI Number Information
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NPI Number | 1407697865
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Entity Type | Organization
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Legal Business Name | BROTHERS CARE GROUP HOMES LLC
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Dates
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Enumeration Date | 06/01/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 611 BEAUHAVEN LN
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City | WAXHAW
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State | NC
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Zip | 28173-7451
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Country | US
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Telephone | 617-877-1429
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Fax |
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Provider Business Mailing Address
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Address Line | 611 BEAUHAVEN LN
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City | WAXHAW
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State | NC
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Zip | 28173-7451
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Country | US
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Telephone | 617-877-1429
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KEL DELPHINE NJIKE TAH
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Credential |
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Telephone | 617-877-1429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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