Phillip Brown
Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Hazelwood, MO
NPI 1164045068 · NPPES record last updated May 26, 2020
Key facts
- NPI
- 1164045068
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Practice address
- 4954 Hurstborough CT
Hazelwood, MO 63042-1592 - Phone
- (314) 566-8301
- NPI assigned
- May 26, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | |||
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
4954 Hurstborough CT
Hazelwood, MO 63042-1592
Mailing address
4954 Hurstborough CT
Hazelwood, MO 63042-1592
Phone (314) 566-8301
Other providers in Hazelwood, MO
- Adrienne Brown
- Brittney Danielle Brown
- Crystal Brown
- Jonathan A. Brown
- Jonice Mariano Brown
- Brownridge Pediatrics After Hours P.C.
- Brownridge Pediatrics P.C.
- Earline Abigail Brownridge
- Seth Jonathan Brownridge
- Raegan Bruce-Sanchez
All providers in Hazelwood, MO · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.