Provider Demographics
NPI:1407508161
Name:BRE ENTERPRISES, LLC
Entity type:Organization
Organization Name:BRE ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-314-7846
Mailing Address - Street 1:211 GIBSON STREET, NW
Mailing Address - Street 2:SUITE 123
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2115
Mailing Address - Country:US
Mailing Address - Phone:703-795-8793
Mailing Address - Fax:
Practice Address - Street 1:211 GIBSON STREET, NW
Practice Address - Street 2:SUITE 123
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2115
Practice Address - Country:US
Practice Address - Phone:571-561-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty