Healthcare Provider Details

I. General information

NPI: 1780090910
Provider Name (Legal Business Name): PIKES PEAK NEURO CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 BLAKE ST SUITE 51780
DENVER CO
80202-1321
US

IV. Provider business mailing address

1521 BLAKE ST STE 51780
DENVER CO
80202-1321
US

V. Phone/Fax

Practice location:
  • Phone: 734-245-9892
  • Fax: 360-925-3470
Mailing address:
  • Phone: 734-245-9892
  • Fax: 360-925-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLA BROOKSHIRE
Title or Position: DIRECTOR OF BUSINESS OPERATIONS
Credential:
Phone: 734-245-9892