Provider Demographics
NPI:1497991285
Name:BRANFORD TRANSQUILITY HOUSE
Entity Type:Organization
Organization Name:BRANFORD TRANSQUILITY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-637-5963
Mailing Address - Street 1:7820 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4515
Mailing Address - Country:US
Mailing Address - Phone:919-637-5963
Mailing Address - Fax:
Practice Address - Street 1:721 VAN THOMAS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5242
Practice Address - Country:US
Practice Address - Phone:919-637-5963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-27
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No251C00000XAgenciesDay Training, Developmentally Disabled Services