Provider Demographics
NPI:1083687958
Name:THE BRAIN INJURY RECOVERY NETWORK
Entity Type:Organization
Organization Name:THE BRAIN INJURY RECOVERY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:J
Authorized Official - Last Name:SZABO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-743-9949
Mailing Address - Street 1:840 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45005-3128
Mailing Address - Country:US
Mailing Address - Phone:937-743-9949
Mailing Address - Fax:937-743-9949
Practice Address - Street 1:840 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45005-3128
Practice Address - Country:US
Practice Address - Phone:937-743-9949
Practice Address - Fax:937-743-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2398356Medicaid