1114120946 NPI number — BROWN HAND CENTER PHOENIX LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114120946 NPI number — BROWN HAND CENTER PHOENIX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWN HAND CENTER PHOENIX LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114120946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 925185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77292-5185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-586-6778
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9377 E BELL RD
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-583-2161
Provider Business Practice Location Address Fax Number:
480-585-9961
Provider Enumeration Date:
06/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JO ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING ASST
Authorized Official Telephone Number:
713-586-6778

Provider Taxonomy Codes

  • Taxonomy code: 2086S0105X , with the licence number:  36511 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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