Provider Demographics
NPI:1992701486
Name:BRYNN MARR HOSPITAL INC
Entity type:Organization
Organization Name:BRYNN MARR HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3482
Mailing Address - Street 1:192 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7238
Mailing Address - Country:US
Mailing Address - Phone:910-577-1400
Mailing Address - Fax:910-577-2766
Practice Address - Street 1:192 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7238
Practice Address - Country:US
Practice Address - Phone:910-577-1400
Practice Address - Fax:910-577-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHH0190283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404016Medicaid
NC00066OtherBCBS
NC3404016Medicaid