Provider Demographics
NPI:1588720155
Name:BRAY INC
Entity type:Organization
Organization Name:BRAY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-821-0588
Mailing Address - Street 1:16655 W BLUEMOUND ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-821-0588
Mailing Address - Fax:262-821-0599
Practice Address - Street 1:16655 W BLUEMOUND ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-821-0588
Practice Address - Fax:262-821-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42174600Medicaid