MEDICARE: BROOKIE L FAVORS

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
1	3747A0650X	Attendant Care Provider	RS885870	OH

General Provider Information

NPI Number	:	1396696753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKIE L FAVORS

Provider Business Mailing Address
First Line	:	4305 E 164TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 E 164TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2411
Country	:	US
Telephone Number	:	216-533-0446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ BROOKIE L FAVORS ” Practice Location

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