Provider Demographics
NPI:1326110750
Name:BRAVIS ENTERPRISES, INC.
Entity Type:Organization
Organization Name:BRAVIS ENTERPRISES, INC.
Other - Org Name:BUTLER REHABILITATION CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:CMA (AAMA)
Authorized Official - Phone:724-282-0755
Mailing Address - Street 1:1610 N. MAIN STREET EXT.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-7612
Mailing Address - Country:US
Mailing Address - Phone:724-282-0755
Mailing Address - Fax:724-282-7723
Practice Address - Street 1:1610 N. MAIN STREET EXT.
Practice Address - Street 2:SUITE 100
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5682
Practice Address - Country:US
Practice Address - Phone:724-282-0755
Practice Address - Fax:724-282-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA394560261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394560Medicare Oscar/Certification