Provider Demographics
NPI:1518097716
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 1:839 MAJESTIC CT
Mailing Address - Street 2:UNIT 5
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5147
Mailing Address - Country:US
Mailing Address - Phone:704-215-5605
Mailing Address - Fax:704-215-5608
Practice Address - Street 1:1556 UNION RD STE C
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2208
Practice Address - Country:US
Practice Address - Phone:980-474-4032
Practice Address - Fax:804-744-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005949Medicaid
NC8303293Medicaid