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General NPI Number Information
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NPI Number | 1245778299
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Entity Type | Organization
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Legal Business Name | FRED BROWN'S RECOVERY SERVICES, INC.
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 856 W 19TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-5314
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Country | US
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Telephone | 310-519-8723
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Fax | 310-519-9428
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Provider Business Mailing Address
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Address Line | 270 W 14TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-4315
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Country | US
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Telephone | 310-519-8723
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Fax | 310-519-9428
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ROXANNA LYNN NATALE-BROWN
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Credential | LAADCNR, CADCII, SAP
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Telephone | 310-519-8723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190135EN
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License Number State | CA
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