Healthcare Provider Details

I. General information

NPI: 1588175012
Provider Name (Legal Business Name): M BROWN RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7207 EVERGREEN WAY STE M
EVERETT WA
98203-5678
US

IV. Provider business mailing address

7207 EVERGREEN WAY STE M
EVERETT WA
98203-5678
US

V. Phone/Fax

Practice location:
  • Phone: 425-347-9070
  • Fax: 425-348-3676
Mailing address:
  • Phone: 425-347-9070
  • Fax: 425-348-3676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number037600
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT B FROMM
Title or Position: CLINICAL SUPERVISOR
Credential: CDP, BS
Phone: 425-347-9070