Provider Demographics
NPI:1467228072
Name:BRANMARC, INC. FAMILY SERVICES
Entity Type:Organization
Organization Name:BRANMARC, INC. FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CCO
Authorized Official - Prefix:
Authorized Official - First Name:DEMICO
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-957-1364
Mailing Address - Street 1:1926 PINE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-7617
Mailing Address - Country:US
Mailing Address - Phone:980-474-4032
Mailing Address - Fax:
Practice Address - Street 1:3061 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-6076
Practice Address - Country:US
Practice Address - Phone:704-671-4087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children