Provider Demographics
NPI:1376174904
Name:KAREN BROSIUS LLC
Entity Type:Organization
Organization Name:KAREN BROSIUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-340-3470
Mailing Address - Street 1:901 S ROGERS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4760
Mailing Address - Country:US
Mailing Address - Phone:812-340-3470
Mailing Address - Fax:
Practice Address - Street 1:901 S ROGERS ST STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4760
Practice Address - Country:US
Practice Address - Phone:812-340-3470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)