Provider Demographics
NPI:1437372737
Name:DONALD BROWN SR.
Entity Type:Organization
Organization Name:DONALD BROWN SR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHAUN
Authorized Official - Middle Name:ANJALI
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-949-7497
Mailing Address - Street 1:2015 ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6127
Mailing Address - Country:US
Mailing Address - Phone:919-596-7414
Mailing Address - Fax:919-667-1276
Practice Address - Street 1:2015 ELLIS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6127
Practice Address - Country:US
Practice Address - Phone:919-596-7414
Practice Address - Fax:919-667-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL0324043104A0625X
311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness