Provider Demographics
NPI:1134154370
Name:G & J BREWER LLC
Entity type:Organization
Organization Name:G & J BREWER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-760-7131
Mailing Address - Street 1:3314 HEALY DR
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1408
Mailing Address - Country:US
Mailing Address - Phone:336-760-7131
Mailing Address - Fax:336-760-3046
Practice Address - Street 1:3314 HEALY DR
Practice Address - Street 2:SUITE 105A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1408
Practice Address - Country:US
Practice Address - Phone:336-760-7131
Practice Address - Fax:336-760-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3129251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601370Medicaid
NC3408962Medicaid