Provider Demographics
NPI:1982381760
Name:BEYOND BRINK
Entity Type:Organization
Organization Name:BEYOND BRINK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-779-1075
Mailing Address - Street 1:314 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3032
Mailing Address - Country:US
Mailing Address - Phone:507-779-1075
Mailing Address - Fax:507-779-7091
Practice Address - Street 1:700 RAYMOND AVE STE 130
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1778
Practice Address - Country:US
Practice Address - Phone:507-779-1075
Practice Address - Fax:507-779-7092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEYOND BRINK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty