Provider Demographics
NPI:1407221757
Name:BRAINSTORM LLC
Entity Type:Organization
Organization Name:BRAINSTORM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHONZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-580-0970
Mailing Address - Street 1:1400 HAWK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-4871
Mailing Address - Country:US
Mailing Address - Phone:214-580-0970
Mailing Address - Fax:
Practice Address - Street 1:1400 HAWK VALLEY DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-4871
Practice Address - Country:US
Practice Address - Phone:214-580-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802342054343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)