Provider Demographics
NPI:1063570547
Name:BRANDON RESIDENTIAL TREATMENT CENTER, INC.
Entity type:Organization
Organization Name:BRANDON RESIDENTIAL TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:508-655-6400
Mailing Address - Street 1:27 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1015
Mailing Address - Country:US
Mailing Address - Phone:508-655-6400
Mailing Address - Fax:508-650-9431
Practice Address - Street 1:27 WINTER ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1015
Practice Address - Country:US
Practice Address - Phone:508-655-6400
Practice Address - Fax:508-650-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4903992322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children