Provider Demographics
NPI:1144551607
Name:BREANNA ADULT/CHILDREN LEARNING CNTR. CHEMICAL DEPENDENCYLLC
Entity type:Organization
Organization Name:BREANNA ADULT/CHILDREN LEARNING CNTR. CHEMICAL DEPENDENCYLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-798-0130
Mailing Address - Street 1:219 S EAST ST STE A
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1536
Mailing Address - Country:US
Mailing Address - Phone:919-809-7899
Mailing Address - Fax:919-809-7878
Practice Address - Street 1:219 S EAST ST STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1536
Practice Address - Country:US
Practice Address - Phone:919-809-7899
Practice Address - Fax:919-809-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-23
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)Group - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility