Provider Demographics
NPI:1235688417
Name:BRENDI MTZ, LLC
Entity type:Organization
Organization Name:BRENDI MTZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VISITATION FACILITATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-460-0362
Mailing Address - Street 1:3526 N CASCADE AVE LOT D8
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5245
Mailing Address - Country:US
Mailing Address - Phone:719-460-0362
Mailing Address - Fax:
Practice Address - Street 1:3526 N CASCADE AVE LOT D8
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5245
Practice Address - Country:US
Practice Address - Phone:719-460-0362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management