Healthcare Provider Details

I. General information

NPI: 1114601309
Provider Name (Legal Business Name): BROWNSTONE HOMES OF REFUGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W 90TH ST
LOS ANGELES CA
90044-5724
US

IV. Provider business mailing address

560 W 90TH ST
LOS ANGELES CA
90044-5724
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5427
  • Fax:
Mailing address:
  • Phone: 323-442-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL BROWN
Title or Position: OWNER
Credential:
Phone: 323-422-5427