Organization · NPI-2

Broom Homestead INC

Case Manager/Care Coordinator · Los Angeles, CA

NPI number1134926769
StatusActive
Last updated in NPPESApr 2, 2025

Details

NPI
1134926769
Entity type
Organization (NPI-2)
Legal business name
Broom Homestead INC
Organization subpart
No
Enumeration date
Mar 1, 2025
Certification date
Apr 2, 2025
Last updated
Apr 2, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
171M00000X Case Manager/Care Coordinator––Yes
320800000X Community Based Residential Treatment Facility, Mental Illness––

Other names

  • Edrica'S House Of Hope (Doing Business As)

Practice location

3616 10th Ave
Los Angeles, CA 90018-4113

Phone 323-643-4869 · Fax 323-643-4869

Mailing address

3616 10th Ave
Los Angeles, CA 90018-4113

Phone 323-643-4869 · Fax 323-643-4869

Authorized official

Walter E Broom
Ceo/Executive Director
3236434869

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