Provider Demographics
NPI:1831732312
Name:THE BRANCH COMMUNITY GROUP
Entity type:Organization
Organization Name:THE BRANCH COMMUNITY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:BAGWELL
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP,QDDP
Authorized Official - Phone:757-709-9001
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:ACCOMAC
Mailing Address - State:VA
Mailing Address - Zip Code:23301-0306
Mailing Address - Country:US
Mailing Address - Phone:757-709-9001
Mailing Address - Fax:757-787-3456
Practice Address - Street 1:24293 LANKFORD HIGHWAY
Practice Address - Street 2:
Practice Address - City:TASLEY
Practice Address - State:VA
Practice Address - Zip Code:23441
Practice Address - Country:US
Practice Address - Phone:757-709-9001
Practice Address - Fax:757-787-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services