Provider Demographics
NPI:1225084346
Name:BROWN'S HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BROWN'S HEALTHCARE, LLC
Other - Org Name:BROWN'S HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYGH
Authorized Official - Middle Name:ANGWIN
Authorized Official - Last Name:BROGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-650-8773
Mailing Address - Street 1:1145 HEMBREE RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1122
Mailing Address - Country:US
Mailing Address - Phone:770-650-8773
Mailing Address - Fax:770-650-9732
Practice Address - Street 1:226 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5299
Practice Address - Country:US
Practice Address - Phone:912-764-9631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000140434AMedicaid
11-5604Medicare ID - Type UnspecifiedTRAILBLAZER