MEDICARE: BRANDT GROUP HOMES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility		CA

General Provider Information

NPI Number	:	1699815274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDT GROUP HOMES INC

Provider Business Mailing Address
First Line	:	5421 HARRISON ST
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5042
Country	:	US
Telephone Number	:	916-331-1757
Fax Number	:	916-331-1165

Provider Business Practice Location Address
First Line	:	3653 CENTINELLA DR
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-3735
Country	:	US
Telephone Number	:	916-348-9804
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VICKI ANN BRANDT
Credential	:
Telephone Number	:	916-331-1757

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/22/2020

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