Provider Demographics
NPI:1144604307
Name:AMC, LLC D/B/A BRAINWORX ACADEMY
Entity Type:Organization
Organization Name:AMC, LLC D/B/A BRAINWORX ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-625-8061
Mailing Address - Street 1:641 UNIVERSITY BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2792
Mailing Address - Country:US
Mailing Address - Phone:561-625-8061
Mailing Address - Fax:561-625-9350
Practice Address - Street 1:641 UNIVERSITY BLVD STE 108
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2792
Practice Address - Country:US
Practice Address - Phone:561-625-8061
Practice Address - Fax:561-625-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization