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NPI Code Detail

MEDICARE: BROKHIM, LLC

MEDICARE: BROKHIM, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1311Z00000XCustodial Care Facility197607392CA

General Provider Information

NPI Number : 1073767273
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROKHIM, LLC
Provider Business Mailing Address
First Line : 1015 S ORANGE GROVE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90019-6510
Country : US
Telephone Number : 323-933-8271
Fax Number : 323-933-8273
Provider Business Practice Location Address
First Line : 1015 S ORANGE GROVE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90019-6510
Country : US
Telephone Number : 323-933-8271
Fax Number : 323-933-8273
Authorized Official
Title or Position : OWNER
Name : MS. MICHELLE BROKHIM
Credential :
Telephone Number : 323-933-8271
Provider Enumeration Date : 11/14/2008
Last Update Date : 11/14/2008

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Directions to “BROKHIM, LLC ” Practice Location

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