Healthcare Provider Details

I. General information

NPI: 1922968288
Provider Name (Legal Business Name): BROUGHTONS REFUGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MEMORIAL DR # D
DECATUR GA
30032-2700
US

IV. Provider business mailing address

1445 WOODMONT LN NW # 2334
ATLANTA GA
30318-2866
US

V. Phone/Fax

Practice location:
  • Phone: 888-408-6286
  • Fax:
Mailing address:
  • Phone: 888-408-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONNA RICHARDSON
Title or Position: MANAGE
Credential:
Phone: 281-509-4565