Provider Demographics
NPI:1356618672
Name:BRYANT HOMES, LLC.
Entity type:Organization
Organization Name:BRYANT HOMES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHLKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:414-241-7067
Mailing Address - Street 1:12501 W. NEEDHAM DR.
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151
Mailing Address - Country:US
Mailing Address - Phone:414-241-7067
Mailing Address - Fax:
Practice Address - Street 1:12501 W NEEDHAM DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-1847
Practice Address - Country:US
Practice Address - Phone:414-241-7067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities