Provider Demographics
NPI:1780900472
Name:BRAINWORX, LLC
Entity type:Organization
Organization Name:BRAINWORX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:G.
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-845-1999
Mailing Address - Street 1:9767 FALL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4713
Mailing Address - Country:US
Mailing Address - Phone:317-845-1999
Mailing Address - Fax:317-845-0337
Practice Address - Street 1:9767 FALL CREEK RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4713
Practice Address - Country:US
Practice Address - Phone:317-845-1999
Practice Address - Fax:317-845-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty