Provider Demographics
NPI:1750089330
Name:BREERIC LLC
Entity type:Organization
Organization Name:BREERIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-362-1157
Mailing Address - Street 1:809 PROFESSIONAL PLACE, BLDG A
Mailing Address - Street 2:UNIT 103
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-362-1157
Mailing Address - Fax:
Practice Address - Street 1:1109 S MILITARY HWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2347
Practice Address - Country:US
Practice Address - Phone:757-362-1157
Practice Address - Fax:757-260-7988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREERIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-22
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017627240002Medicaid
VAHCO263306OtherSTATE LICENSE