Provider Demographics
NPI:1912252958
Name:SOUTHSIDE BEHAVIORAL HEALTH - BRANDON HOME
Entity Type:Organization
Organization Name:SOUTHSIDE BEHAVIORAL HEALTH - BRANDON HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-572-6916
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-1478
Mailing Address - Country:US
Mailing Address - Phone:434-570-1524
Mailing Address - Fax:434-374-3221
Practice Address - Street 1:51 POPLAR CREEK ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-5346
Practice Address - Country:US
Practice Address - Phone:434-575-7707
Practice Address - Fax:434-575-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities