Provider Demographics
NPI:1851107544
Name:RCH BRAIN & MIND CENTER VA, PC
Entity type:Organization
Organization Name:RCH BRAIN & MIND CENTER VA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ANAYLST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-629-0752
Mailing Address - Street 1:1307 8TH AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4143
Mailing Address - Country:US
Mailing Address - Phone:682-394-3500
Mailing Address - Fax:817-862-7238
Practice Address - Street 1:8316 ARLINGTON BLVD STE 420
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5216
Practice Address - Country:US
Practice Address - Phone:571-307-2741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty