Provider Demographics
NPI:1295272730
Name:GREENBROOK TMS WILMINGTON LLC
Entity type:Organization
Organization Name:GREENBROOK TMS WILMINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GREATER BALTIMORE REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EGAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:855-755-4867
Mailing Address - Street 1:8405 GREENSBORO DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-5104
Mailing Address - Country:US
Mailing Address - Phone:855-333-4867
Mailing Address - Fax:
Practice Address - Street 1:410 FOULK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3820
Practice Address - Country:US
Practice Address - Phone:855-755-4867
Practice Address - Fax:855-250-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center