Provider Demographics
NPI:1407697865
Name:BROTHERS CARE GROUP HOMES LLC
Entity type:Organization
Organization Name:BROTHERS CARE GROUP HOMES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEL
Authorized Official - Middle Name:DELPHINE
Authorized Official - Last Name:NJIKE TAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-877-1429
Mailing Address - Street 1:611 BEAUHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7451
Mailing Address - Country:US
Mailing Address - Phone:617-877-1429
Mailing Address - Fax:
Practice Address - Street 1:611 BEAUHAVEN LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7451
Practice Address - Country:US
Practice Address - Phone:617-877-1429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-01
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility