Provider Demographics
NPI:1215316138
Name:BRAIN INJURY SERVCIES
Entity type:Organization
Organization Name:BRAIN INJURY SERVCIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-451-8881
Mailing Address - Street 1:8136 OLD KEENE MILL RD
Mailing Address - Street 2:SUITE B102
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1850
Mailing Address - Country:US
Mailing Address - Phone:703-451-8881
Mailing Address - Fax:703-451-8820
Practice Address - Street 1:8136 OLD KEENE MILL RD
Practice Address - Street 2:SUITE B102
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1850
Practice Address - Country:US
Practice Address - Phone:703-451-8881
Practice Address - Fax:703-451-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2024-09-03
Deactivation Date:2024-02-08
Deactivation Code:
Reactivation Date:2024-02-29
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury MedicineGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty