Provider Demographics
NPI:1326231952
Name:FRED BROWN'S RECOVERY SERVICES
Entity Type:Organization
Organization Name:FRED BROWN'S RECOVERY SERVICES
Other - Org Name:FRED BROWN RECOVERY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATALE-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LAADCNR, CADCII, SAP
Authorized Official - Phone:310-519-8723
Mailing Address - Street 1:270 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-4315
Mailing Address - Country:US
Mailing Address - Phone:310-519-8723
Mailing Address - Fax:
Practice Address - Street 1:270 W 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-4315
Practice Address - Country:US
Practice Address - Phone:310-519-8723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190135CN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility