Provider Demographics
NPI:1437397627
Name:BRIAR ROSE CENTER, THE HOME OF HOPE
Entity type:Organization
Organization Name:BRIAR ROSE CENTER, THE HOME OF HOPE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:509-496-2857
Mailing Address - Street 1:11802 E MANSFIELD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4788
Mailing Address - Country:US
Mailing Address - Phone:509-496-2857
Mailing Address - Fax:509-343-1622
Practice Address - Street 1:11802 E MANSFIELD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4788
Practice Address - Country:US
Practice Address - Phone:509-496-2857
Practice Address - Fax:509-343-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602686727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7142250Medicaid