Provider Demographics
NPI:1457768715
Name:BRAINCARE, LLC
Entity Type:Organization
Organization Name:BRAINCARE, LLC
Other - Org Name:GLOBAL NEURO-DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-848-2522
Mailing Address - Street 1:2670 FIREWHEEL DR
Mailing Address - Street 2:STE B
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4601
Mailing Address - Country:US
Mailing Address - Phone:866-848-2522
Mailing Address - Fax:877-290-1544
Practice Address - Street 1:720 CORPORATE CIR
Practice Address - Street 2:STE A-6
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5641
Practice Address - Country:US
Practice Address - Phone:866-848-2522
Practice Address - Fax:877-290-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO412053Medicare PIN