Provider Demographics
NPI:1285978155
Name:BROW, LLC
Entity type:Organization
Organization Name:BROW, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-735-6209
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-0561
Mailing Address - Country:US
Mailing Address - Phone:702-735-6209
Mailing Address - Fax:702-735-6210
Practice Address - Street 1:3750 S JONES BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2208
Practice Address - Country:US
Practice Address - Phone:702-735-6209
Practice Address - Fax:702-735-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20121682715251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297126Medicare Oscar/Certification