Provider Demographics
NPI:1124186978
Name:BRIAR HOUSE FACILITY LPC BRIAR I
Entity Type:Organization
Organization Name:BRIAR HOUSE FACILITY LPC BRIAR I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-587-4919
Mailing Address - Street 1:10133 W BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HALES CORNER
Mailing Address - State:WI
Mailing Address - Zip Code:53130
Mailing Address - Country:US
Mailing Address - Phone:414-427-9344
Mailing Address - Fax:414-427-1088
Practice Address - Street 1:10133 W BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:HALES CORNER
Practice Address - State:WI
Practice Address - Zip Code:53130
Practice Address - Country:US
Practice Address - Phone:414-427-9344
Practice Address - Fax:414-427-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility