Provider Demographics
NPI:1730988502
Name:BROOKE CREDENTIALING & CONSULTING, LLC
Entity type:Organization
Organization Name:BROOKE CREDENTIALING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-569-4712
Mailing Address - Street 1:509 CHATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1709
Mailing Address - Country:US
Mailing Address - Phone:719-569-4712
Mailing Address - Fax:
Practice Address - Street 1:509 CHATFIELD DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1709
Practice Address - Country:US
Practice Address - Phone:719-569-4712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service