Healthcare Provider Details

I. General information

NPI: 1497402986
Provider Name (Legal Business Name): BRAINWORK SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W ROYALE DR
MUNCIE IN
47304-2235
US

IV. Provider business mailing address

1400 W ROYALE DR
MUNCIE IN
47304-2235
US

V. Phone/Fax

Practice location:
  • Phone: 317-324-0329
  • Fax: 317-754-7325
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARMAYNE A DUERSON-SHOEMAKER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-329-2291