Provider Demographics
NPI:1164287959
Name:BRANDGOV
Entity Type:Organization
Organization Name:BRANDGOV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-332-7825
Mailing Address - Street 1:4825 FERNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6856
Mailing Address - Country:US
Mailing Address - Phone:707-332-7825
Mailing Address - Fax:
Practice Address - Street 1:425 VIRGINIA ST STE B
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6017
Practice Address - Country:US
Practice Address - Phone:707-332-7825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health