Provider Demographics
NPI:1093061863
Name:KERRY BRAMON REMODELING AND DESIGN
Entity Type:Organization
Organization Name:KERRY BRAMON REMODELING AND DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-875-0794
Mailing Address - Street 1:1204 ROGERS ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4736
Mailing Address - Country:US
Mailing Address - Phone:573-875-0794
Mailing Address - Fax:573-443-3841
Practice Address - Street 1:1204 ROGERS ST
Practice Address - Street 2:SUITE G
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-4736
Practice Address - Country:US
Practice Address - Phone:573-875-0794
Practice Address - Fax:573-443-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320900000X
MO332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities