Provider Demographics
NPI:1508925538
Name:BRITTANY RESIDENTIAL INC
Entity Type:Organization
Organization Name:BRITTANY RESIDENTIAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-428-6648
Mailing Address - Street 1:3100 ARCOLA ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3035
Mailing Address - Country:US
Mailing Address - Phone:440-428-6648
Mailing Address - Fax:440-428-4696
Practice Address - Street 1:3100 ARCOLA ROAD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3035
Practice Address - Country:US
Practice Address - Phone:440-428-6648
Practice Address - Fax:440-428-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0949791Medicaid