Provider Demographics
NPI:1831230218
Name:BRABETZ, INC.
Entity type:Organization
Organization Name:BRABETZ, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRABETZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CPNP, PHN
Authorized Official - Phone:707-546-8773
Mailing Address - Street 1:1378A CORPORATE CENTER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5462
Mailing Address - Country:US
Mailing Address - Phone:707-546-8773
Mailing Address - Fax:707-546-8788
Practice Address - Street 1:1378A CORPORATE CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5462
Practice Address - Country:US
Practice Address - Phone:707-546-8773
Practice Address - Fax:707-546-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000349251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70290FMedicaid