Provider Demographics
NPI:1275663551
Name:MY BROTHAZ H.O.M.E., INC.
Entity Type:Organization
Organization Name:MY BROTHAZ H.O.M.E., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-231-8727
Mailing Address - Street 1:2111 PRICE ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-9049
Mailing Address - Country:US
Mailing Address - Phone:912-231-8727
Mailing Address - Fax:912-231-8730
Practice Address - Street 1:2111 PRICE ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-9049
Practice Address - Country:US
Practice Address - Phone:912-231-8727
Practice Address - Fax:912-231-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare