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General NPI Number Information
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NPI Number | 1639147275
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Entity Type | Organization
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Legal Business Name | THE BRAMBLEX
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 BELLA TERRA ROAD
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City | NORTH
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State | VA
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Zip | 23128-0126
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Country | US
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Telephone | 804-725-3800
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Fax | 804-725-3999
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Provider Business Mailing Address
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Address Line | PO BOX 126
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City | NORTH
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State | VA
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Zip | 23128-0126
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Country | US
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Telephone | 804-725-3800
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Fax | 804-725-3999
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. CLYDE H FORREST
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Credential |
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Telephone | 804-725-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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