Provider Demographics
NPI:1538613302
Name:BRAIN TRAINING CENTER OF CHARLOTTE
Entity type:Organization
Organization Name:BRAIN TRAINING CENTER OF CHARLOTTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER AND OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-386-3470
Mailing Address - Street 1:10030 EDISON SQUARE DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8308
Mailing Address - Country:US
Mailing Address - Phone:704-499-8888
Mailing Address - Fax:704-499-8888
Practice Address - Street 1:10030 EDISON SQUARE DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8308
Practice Address - Country:US
Practice Address - Phone:704-499-8888
Practice Address - Fax:704-499-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty