Provider Demographics
NPI:1336134238
Name:JOSEPH D. BRANDENBURG CENTER
Entity Type:Organization
Organization Name:JOSEPH D. BRANDENBURG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-777-2264
Mailing Address - Street 1:10100 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1722
Mailing Address - Country:US
Mailing Address - Phone:301-777-2264
Mailing Address - Fax:301-777-2399
Practice Address - Street 1:10100 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21501-1722
Practice Address - Country:US
Practice Address - Phone:301-777-2264
Practice Address - Fax:301-777-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01-010320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities