Provider Demographics
NPI:1316398787
Name:BRAINCARE, LLC
Entity type:Organization
Organization Name:BRAINCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:REEGT / MBA
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 1:12301 LAKE UNDERHILL RD STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4511
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:2016-06-28
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory