Provider Demographics
NPI:1922510585
Name:BROTHERS COMMUNITY RESOURCES
Entity Type:Organization
Organization Name:BROTHERS COMMUNITY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALETHEA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARCELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PSYCH, ACAS, ITFS
Authorized Official - Phone:919-609-8160
Mailing Address - Street 1:2556 MINT JULEP DR
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7817
Mailing Address - Country:US
Mailing Address - Phone:919-609-8160
Mailing Address - Fax:
Practice Address - Street 1:2556 MINT JULEP DR
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-7817
Practice Address - Country:US
Practice Address - Phone:919-609-8160
Practice Address - Fax:919-609-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care