NPIMap

Organization Active NPI

Fred Brown's Recovery Services

Doing business as Fred Brown Recovery Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • San Pedro, CA
National Provider Identifier
1528616117
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
FRED BROWN'S RECOVERY SERVICES
Doing business as
Fred Brown Recovery Services
Practice address
505 S Pacific Avenue
Suite 103,104,105,106,203,204,205,206
San Pedro, CA 90731-2656
Phone
(310) 519-8723
Fax
(310) 519-8723
NPI assigned
Aug 28, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angelita Fernando
Title
Administrative Manager
Phone
(310) 519-8723

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

505 S Pacific Avenue
Suite 103,104,105,106,203,204,205,206
San Pedro, CA 90731-2656

Mailing address

PO Box 2743
San Pedro, CA 90731-0182
Phone (310) 519-8723

Other names 1

  • Fred Brown Recovery Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fred Brown's Recovery Services13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

505 S Pacific Ave
Ste 103104105106203204205206
San Pedro, CA 90731

505 S Pacific Ave
#105
San Pedro, CA 90731

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1528616117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2743",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907310182",
            "telephone_number": "310-519-8723",
            "fax_number": "310-519-1309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 S PACIFIC AVENUE",
            "address_2": "SUITE 103,104,105,106,203,204,205,206",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312656",
            "telephone_number": "310-519-8723",
            "fax_number": "310-519-8723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED BROWN'S RECOVERY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-28",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "FERNANDO",
        "authorized_official_first_name": "ANGELITA",
        "authorized_official_title_or_position": "ADMINISTRATIVE MANAGER",
        "authorized_official_telephone_number": "310-519-8723"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fred Brown Recovery Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fred Brown Recovery Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.