Provider Demographics
NPI:1194183129
Name:BRYANT CENTER TECHNICAL CENTER
Entity Type:Organization
Organization Name:BRYANT CENTER TECHNICAL CENTER
Other - Org Name:BRYANT CENTER TECHNICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:SHANARION
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-463-8398
Mailing Address - Street 1:2003 N GIMON CIR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-2348
Mailing Address - Country:US
Mailing Address - Phone:251-463-8398
Mailing Address - Fax:
Practice Address - Street 1:2003 N GIMON CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-2348
Practice Address - Country:US
Practice Address - Phone:251-463-8398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRYANT CENTER TECHNICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home