Provider Demographics
NPI:1184408056
Name:BRAIN INJURY CONNECTIONS OF THE SHENANDOAH VALLEY
Entity type:Organization
Organization Name:BRAIN INJURY CONNECTIONS OF THE SHENANDOAH VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-568-8923
Mailing Address - Street 1:755 MARTIN LUTHER KING, JR. WAY
Mailing Address - Street 2:MSC 9020
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22807
Mailing Address - Country:US
Mailing Address - Phone:540-568-8923
Mailing Address - Fax:540-492-5587
Practice Address - Street 1:755 MARTIN LUTHER KING, JR. WAY
Practice Address - Street 2:MSC 9020
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807
Practice Address - Country:US
Practice Address - Phone:540-568-8923
Practice Address - Fax:540-492-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury MedicineGroup - Single Specialty