Provider Demographics
NPI:1679016760
Name:BROWN'S RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:BROWN'S RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:330-497-9626
Mailing Address - Street 1:6033 MARKET AVE N
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-3122
Mailing Address - Country:US
Mailing Address - Phone:330-497-9626
Mailing Address - Fax:
Practice Address - Street 1:6033 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-3122
Practice Address - Country:US
Practice Address - Phone:330-497-9626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7601107320600000X
347C00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care