Provider Demographics
NPI:1669675278
Name:BRANNON'S FRIENDS LLC
Entity type:Organization
Organization Name:BRANNON'S FRIENDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVIE
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-297-6684
Mailing Address - Street 1:407 E PIRATE ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2427
Mailing Address - Country:US
Mailing Address - Phone:903-297-6684
Mailing Address - Fax:
Practice Address - Street 1:407 E PIRATE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2427
Practice Address - Country:US
Practice Address - Phone:903-297-6684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities