Provider Demographics
NPI:1366216038
Name:ANDERSON, BRANDON GENE
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:GENE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 LAYHIGH RD
Mailing Address - Street 2:
Mailing Address - City:OKEANA
Mailing Address - State:OH
Mailing Address - Zip Code:45053-9551
Mailing Address - Country:US
Mailing Address - Phone:513-200-0973
Mailing Address - Fax:
Practice Address - Street 1:3784 SILAX DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-8680
Practice Address - Country:US
Practice Address - Phone:513-373-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker