Provider Demographics
NPI:1548306566
Name:B.R.O.N. CDC INC
Entity type:Organization
Organization Name:B.R.O.N. CDC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-485-3377
Mailing Address - Street 1:602 MANN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-6240
Mailing Address - Country:US
Mailing Address - Phone:910-485-3377
Mailing Address - Fax:910-485-3388
Practice Address - Street 1:602 MANN ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-6240
Practice Address - Country:US
Practice Address - Phone:910-485-3377
Practice Address - Fax:910-485-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251G00000XAgenciesHospice Care, Community Based
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered251X00000XAgenciesSupports Brokerage
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700415Medicaid