Provider Demographics
NPI:1013036508
Name:BRELAND HEALTH & REHAB GROUP INC.
Entity Type:Organization
Organization Name:BRELAND HEALTH & REHAB GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-569-3630
Mailing Address - Street 1:208 S RED RIVER EXPY
Mailing Address - Street 2:STE E
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-3752
Mailing Address - Country:US
Mailing Address - Phone:940-569-3630
Mailing Address - Fax:940-569-3752
Practice Address - Street 1:1320 NW HOMESTEAD DR
Practice Address - Street 2:STE E
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5243
Practice Address - Country:US
Practice Address - Phone:580-353-6300
Practice Address - Fax:580-353-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640900000225100000X
OKOK2429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1008356996AOtherCRAIG MCBRIDE
OK376591OtherOKLAHOMA MEDICARE
OK100835690AMedicaid
TX167449101Medicaid
OK376591OtherOKLAHOMA MEDICARE
TX456899Medicare UPIN
TX456899Medicare Oscar/Certification