Healthcare Provider Details

I. General information

NPI: 1083435564
Provider Name (Legal Business Name): BRITTANY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date: 12/02/2024
Reactivation Date: 03/20/2026

III. Provider practice location address

3610 CENTRAL AVE STE 400
RIVERSIDE CA
92506-5907
US

IV. Provider business mailing address

3610 CENTRAL AVE STE 400
RIVERSIDE CA
92506-5907
US

V. Phone/Fax

Practice location:
  • Phone: 951-563-7215
  • Fax: 951-379-3424
Mailing address:
  • Phone: 951-563-7215
  • Fax: 951-379-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number60678127535
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: