Provider Demographics
NPI:1801502968
Name:MCGRAW, BROOKSIE LASHAUN
Entity type:Individual
Prefix:
First Name:BROOKSIE
Middle Name:LASHAUN
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 NW 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-6149
Mailing Address - Country:US
Mailing Address - Phone:352-317-1405
Mailing Address - Fax:
Practice Address - Street 1:5311 NW 81ST AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-6149
Practice Address - Country:US
Practice Address - Phone:352-317-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities