Provider Demographics
NPI:1700144730
Name:BRANNON RESIDENTIAL ACHIEVEMENT GROUP, INC
Entity Type:Organization
Organization Name:BRANNON RESIDENTIAL ACHIEVEMENT GROUP, INC
Other - Org Name:BRAG, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:810-670-0408
Mailing Address - Street 1:8345 JACLYN ANN DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2910
Mailing Address - Country:US
Mailing Address - Phone:810-391-6008
Mailing Address - Fax:775-205-1651
Practice Address - Street 1:1376 E HURD RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-7926
Practice Address - Country:US
Practice Address - Phone:810-670-0408
Practice Address - Fax:775-205-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM250256548311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home