Provider Demographics
NPI:1699138438
Name:BRISCOTOWN
Entity type:Organization
Organization Name:BRISCOTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TRENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-805-6111
Mailing Address - Street 1:7357 JELSON FALLS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2654
Mailing Address - Country:US
Mailing Address - Phone:818-805-6111
Mailing Address - Fax:
Practice Address - Street 1:7357 JELSON FALLS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2654
Practice Address - Country:US
Practice Address - Phone:818-805-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health