Provider Demographics
NPI:1952539850
Name:BROTHERS COMMUNITY RESOURCES
Entity Type:Organization
Organization Name:BROTHERS COMMUNITY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELLUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-528-4900
Mailing Address - Street 1:2556 MINT JULEP DR
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7817
Mailing Address - Country:US
Mailing Address - Phone:919-528-4900
Mailing Address - Fax:919-528-1234
Practice Address - Street 1:106 W CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9765
Practice Address - Country:US
Practice Address - Phone:919-528-4900
Practice Address - Fax:919-528-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency