Provider Demographics
NPI:1376159244
Name:BROTHERS AND KEEPERS CORPORATION
Entity Type:Organization
Organization Name:BROTHERS AND KEEPERS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:909-223-1939
Mailing Address - Street 1:2200 E WILLIAMS FIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0764
Mailing Address - Country:US
Mailing Address - Phone:480-630-9933
Mailing Address - Fax:
Practice Address - Street 1:3947 W KIRKLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85142-6836
Practice Address - Country:US
Practice Address - Phone:480-630-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health