Provider Demographics
NPI:1467153809
Name:THORNWOODWELLNESSLLC
Entity type:Organization
Organization Name:THORNWOODWELLNESSLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-470-4522
Mailing Address - Street 1:225 W S BOULDER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1194
Mailing Address - Country:US
Mailing Address - Phone:720-868-9641
Mailing Address - Fax:
Practice Address - Street 1:225 W S BOULDER RD STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1194
Practice Address - Country:US
Practice Address - Phone:720-868-9641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty