Provider Demographics
NPI:1043782238
Name:ONE BROTHER LLC
Entity Type:Organization
Organization Name:ONE BROTHER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGES
Authorized Official - Middle Name:
Authorized Official - Last Name:NKE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:940-390-0045
Mailing Address - Street 1:2440 DOLOSTONE DR
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1698
Mailing Address - Country:US
Mailing Address - Phone:940-390-0045
Mailing Address - Fax:
Practice Address - Street 1:2440 DOLOSTONE DR
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1698
Practice Address - Country:US
Practice Address - Phone:940-390-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities