Provider Demographics
NPI:1114198728
Name:BRAYNE CONCEPTS
Entity Type:Organization
Organization Name:BRAYNE CONCEPTS
Other - Org Name:BAJAN PROFESSIONAL GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-368-8833
Mailing Address - Street 1:2360 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4332
Mailing Address - Country:US
Mailing Address - Phone:239-368-8833
Mailing Address - Fax:239-368-8833
Practice Address - Street 1:2360 E 5TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4332
Practice Address - Country:US
Practice Address - Phone:239-368-8833
Practice Address - Fax:239-368-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-23
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL089333315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692003996Medicaid