Provider Demographics
NPI:1780920488
Name:BRIAN'S HOUSE, INC.
Entity type:Organization
Organization Name:BRIAN'S HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-399-1175
Mailing Address - Street 1:1300 S CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8531
Mailing Address - Country:US
Mailing Address - Phone:610-399-1175
Mailing Address - Fax:610-399-1828
Practice Address - Street 1:1300 S CONCORD RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8531
Practice Address - Country:US
Practice Address - Phone:610-399-1175
Practice Address - Fax:610-399-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133680320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100000184Medicaid