Healthcare Provider Details

I. General information

NPI: 1043177744
Provider Name (Legal Business Name): BRAND NAME ENTERPRISE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 KIPLING ST UNIT A5
WHEAT RIDGE CO
80033-6773
US

IV. Provider business mailing address

4980 KIPLING ST UNIT A5
WHEAT RIDGE CO
80033-6773
US

V. Phone/Fax

Practice location:
  • Phone: 720-500-8205
  • Fax:
Mailing address:
  • Phone: 720-500-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGIE L BRAND
Title or Position: OWNER
Credential:
Phone: 402-238-5487