Healthcare Provider Details

I. General information

NPI: 1073944906
Provider Name (Legal Business Name): KALAISHA BROWN ADMINISTARTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 BARTON BLVD
ROCKLEDGE FL
32955-3190
US

IV. Provider business mailing address

354 LAREDO DR UNIT 106
COCOA FL
32926-5109
US

V. Phone/Fax

Practice location:
  • Phone: 321-501-0217
  • Fax:
Mailing address:
  • Phone: 407-459-3188
  • Fax:

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 TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906644
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: