Provider Demographics
NPI:1629429956
Name:THE JOURNEY BRAIN INJURY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:THE JOURNEY BRAIN INJURY COMMUNITY SERVICES
Other - Org Name:THE JOURNEY BICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:S
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:720-628-9092
Mailing Address - Street 1:1140 US HIGHWAY 287
Mailing Address - Street 2:SUITE 400-298
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7080
Mailing Address - Country:US
Mailing Address - Phone:720-628-9092
Mailing Address - Fax:866-941-5820
Practice Address - Street 1:9423 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-5237
Practice Address - Country:US
Practice Address - Phone:720-557-9337
Practice Address - Fax:866-941-5820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85506371Medicaid