Provider Demographics
NPI:1417369364
Name:BRACE CENTER LLC
Entity Type:Organization
Organization Name:BRACE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-571-5631
Mailing Address - Street 1:1600 CENTRAL DR STE 157
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6028
Mailing Address - Country:US
Mailing Address - Phone:817-267-0909
Mailing Address - Fax:817-283-1868
Practice Address - Street 1:1600 CENTRAL DR STE 157
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6028
Practice Address - Country:US
Practice Address - Phone:817-267-0909
Practice Address - Fax:817-283-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101707OtherTDLR LICENSE NUMBER