Provider Demographics
NPI:1275073967
Name:BRITTNELLE HEALTH SERVICES GROUP LLC
Entity Type:Organization
Organization Name:BRITTNELLE HEALTH SERVICES GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHENITA-ANN
Authorized Official - Middle Name:PATRECE
Authorized Official - Last Name:GRYMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-749-7432
Mailing Address - Street 1:312 DIVISION AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019
Mailing Address - Country:US
Mailing Address - Phone:202-253-9683
Mailing Address - Fax:
Practice Address - Street 1:312 DIVISION AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5442
Practice Address - Country:US
Practice Address - Phone:202-253-9683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251X00000XAgenciesSupports BrokerageGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty