Provider Demographics
NPI:1639147275
Name:THE BRAMBLEX
Entity Type:Organization
Organization Name:THE BRAMBLEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:H
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-725-3800
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:VA
Mailing Address - Zip Code:23128-0126
Mailing Address - Country:US
Mailing Address - Phone:804-725-3800
Mailing Address - Fax:804-725-3999
Practice Address - Street 1:300 BELLA TERRA ROAD
Practice Address - Street 2:
Practice Address - City:NORTH
Practice Address - State:VA
Practice Address - Zip Code:23128-0126
Practice Address - Country:US
Practice Address - Phone:804-725-3800
Practice Address - Fax:804-725-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities