Provider Demographics
NPI:1700390762
Name:BRENNAN'S HOME L.L.C.
Entity Type:Organization
Organization Name:BRENNAN'S HOME L.L.C.
Other - Org Name:BRENNAN'S HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-503-1036
Mailing Address - Street 1:54 THE LEGENDS PKWY STE 155
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3803
Mailing Address - Country:US
Mailing Address - Phone:314-965-7824
Mailing Address - Fax:
Practice Address - Street 1:54 THE LEGENDS PKWY STE 155
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3803
Practice Address - Country:US
Practice Address - Phone:314-965-7824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities