Provider Demographics
NPI:1366041824
Name:BRAINHEALTH LLC
Entity Type:Organization
Organization Name:BRAINHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, BCIA
Authorized Official - Phone:941-350-9223
Mailing Address - Street 1:2840 W BAY DR UNIT 306
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2620
Mailing Address - Country:US
Mailing Address - Phone:941-350-9223
Mailing Address - Fax:
Practice Address - Street 1:585 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4921
Practice Address - Country:US
Practice Address - Phone:941-350-9223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty