Provider Demographics
NPI:1073024972
Name:BRECOL SUPPORTED CARE LLC
Entity Type:Organization
Organization Name:BRECOL SUPPORTED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-286-5413
Mailing Address - Street 1:1209 HILL RD N # 337
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8888
Mailing Address - Country:US
Mailing Address - Phone:614-286-5413
Mailing Address - Fax:
Practice Address - Street 1:13022 HEATHERSTONE CIR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9050
Practice Address - Country:US
Practice Address - Phone:614-286-5413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care