Provider Demographics
NPI:1063651479
Name:BROWNS BOARDING ALF
Entity type:Organization
Organization Name:BROWNS BOARDING ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN WITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-747-5102
Mailing Address - Street 1:113 11TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8753
Mailing Address - Country:US
Mailing Address - Phone:941-747-5102
Mailing Address - Fax:941-748-7102
Practice Address - Street 1:113 11TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8753
Practice Address - Country:US
Practice Address - Phone:941-747-5102
Practice Address - Fax:941-748-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688379296Medicaid