Provider Demographics
NPI:1447705181
Name:BRAIN@WORK LLC
Entity type:Organization
Organization Name:BRAIN@WORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROETS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-671-9900
Mailing Address - Street 1:1095 STAFFORD WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3333
Mailing Address - Country:US
Mailing Address - Phone:530-671-9900
Mailing Address - Fax:
Practice Address - Street 1:1095 STAFFORD WAY
Practice Address - Street 2:SUITE D
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3333
Practice Address - Country:US
Practice Address - Phone:530-671-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty