Healthcare Provider Details

I. General information

NPI: 1679016760
Provider Name (Legal Business Name): BROWN'S RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6033 MARKET AVE N
CANTON OH
44721-3122
US

IV. Provider business mailing address

6033 MARKET AVE N
CANTON OH
44721-3122
US

V. Phone/Fax

Practice location:
  • Phone: 330-497-9626
  • Fax:
Mailing address:
  • Phone: 330-497-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number7601107
License Number StateOH

VIII. Authorized Official

Name: MR. MARK DOUGLAS BROWN I
Title or Position: CEO
Credential:
Phone: 330-497-9626