Provider Demographics
NPI:1801008594
Name:DISCIPLE HOMES CORP
Entity Type:Organization
Organization Name:DISCIPLE HOMES CORP
Other - Org Name:BETHANY TOWERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY J
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-467-3121
Mailing Address - Street 1:1745 N GRAMERCY PL
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5863
Mailing Address - Country:US
Mailing Address - Phone:323-467-3121
Mailing Address - Fax:323-469-0627
Practice Address - Street 1:1745 N GRAMERCY PL
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-5863
Practice Address - Country:US
Practice Address - Phone:323-467-3121
Practice Address - Fax:323-469-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center