Provider Demographics
NPI:1346757259
Name:BROWN'S TRANSITIONAL SUPPORTED LIVING OF FL,LLC
Entity Type:Organization
Organization Name:BROWN'S TRANSITIONAL SUPPORTED LIVING OF FL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-651-6049
Mailing Address - Street 1:5831 LISKA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-2183
Mailing Address - Country:US
Mailing Address - Phone:904-651-6049
Mailing Address - Fax:
Practice Address - Street 1:5831 LISKA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-2183
Practice Address - Country:US
Practice Address - Phone:904-651-6049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities