Healthcare Provider Details

I. General information

NPI: 1427810548
Provider Name (Legal Business Name): PAINTED BRAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 W 1ST ST
LOS ANGELES CA
90004-6000
US

IV. Provider business mailing address

777 S ALAMEDA ST FL 2
LOS ANGELES CA
90021-1656
US

V. Phone/Fax

Practice location:
  • Phone: 213-289-3578
  • Fax:
Mailing address:
  • Phone: 213-289-3578
  • Fax: 213-357-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAYSHELL CHAMBERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-474-0444