Provider Demographics
NPI:1659520260
Name:BRAIN TRAUMA RECOVERY INSTITUTE, PLC
Entity Type:Organization
Organization Name:BRAIN TRAUMA RECOVERY INSTITUTE, PLC
Other - Org Name:BTRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-901-9091
Mailing Address - Street 1:1515 MICHIGAN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2031
Mailing Address - Country:US
Mailing Address - Phone:616-901-9091
Mailing Address - Fax:
Practice Address - Street 1:1515 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2031
Practice Address - Country:US
Practice Address - Phone:616-901-9091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health