Organization
BROOM HOMESTEAD INC
Active
Other names
Edrica's House of Hope
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER E BROOM CADC II (CEO/EXECUTIVE DIRECTOR)
(323) 643-4869
Entity
Organization
Contact information
Practice address
3616 10TH AVE, LOS ANGELES, CA 90018-4113
(323) 643-4869
(323) 643-4869
Mailing address
3616 10TH AVE, LOS ANGELES, CA 90018-4113
(323) 643-4869
(323) 643-4869
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B1305161051
SUBSTANCE/ADDICTION COUNSELOR
CA
Enumeration date
03/01/2025
Last updated
04/02/2025
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