Provider Demographics
NPI:1386478451
Name:BRAINCARE TBI LLC
Entity type:Organization
Organization Name:BRAINCARE TBI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:OCHIENG
Authorized Official - Last Name:MBEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-839-4889
Mailing Address - Street 1:1500 NORTH LOOP # 1021
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 NORTH LOOP # 1021
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-1216
Practice Address - Country:US
Practice Address - Phone:443-839-4889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty