Provider Demographics
NPI:1306008438
Name:BROTHERS KEEPER INC
Entity Type:Organization
Organization Name:BROTHERS KEEPER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-353-3585
Mailing Address - Street 1:4110 FITZHUGH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3827
Mailing Address - Country:US
Mailing Address - Phone:804-353-3585
Mailing Address - Fax:804-353-3588
Practice Address - Street 1:4110 FITZHUGH AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3827
Practice Address - Country:US
Practice Address - Phone:804-353-3585
Practice Address - Fax:804-353-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1088251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health