BROOKSIDE VILLAGE, INC (NPI# 1265419428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265419428 |
| Entity Type | Organization |
| Organization Name | BROOKSIDE VILLAGE, INC |
| Practice Address |
1111 Church Ave Jasper IN 47546-3761 |
| Mailing Address |
2749 E Covenanter Dr Bloomington IN 47401-5454 |
| Practice Telephone | 8126347750 |
| Practice Fax Number | 8126347751 |
| Mailing Telephone | 8123322265 |
| Mailing Fax Number | 8123340853 |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2017-03-20 |
| Authorized Official Name | DR. STEPHEN G. MOORE (PRESIDENT/CEO) |
| Authorized Official Telephone | 8123322265 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 050032401 | IN | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201274720A | 05 |
| Street Address |
1111 CHURCH AVE |
| City | JASPER |
| State | IN |
| Zip Code | 47546-3761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255754123 | Christine Marie Martin | Occupational Therapist | 1111 Church Ave, Jasper, IN 47546-3761 | 2014-01-29 |
| 1528212867 | Stephanie Young | Physical Therapy Assistant | 1111 Church Ave, Jasper, IN 47546-3761 | 2008-11-13 |
| 1871747725 | Angela Rennie | Physical Therapy Assistant | 1111 Church Ave, Jasper, IN 47546-3761 | 2008-11-05 |
| 1902058837 | Laurie Mehringer | Speech-Language Pathologist | 1111 Church Ave, Jasper, IN 47546-3761 | 2008-10-22 |
| 1154594869 | Donna Michelle Lane | Physical Therapist | 1111 Church Ave, Jasper, IN 47546-3761 | 2008-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497303572 | Marissa L Brosmer | Registered Nurse | 440 Scott Rolen Drive, Jasper, IN 47546 | 2019-08-30 |
| 1154887040 | Jesc LLC | Clinic/Center | 647 West Second Street Suite A, Jasper, IN 47546 | 2019-02-15 |
| 1427384858 | Therapro LLC | Clinic/Center | 306 1/2 Main Street, Jasper, IN 47546 | 2009-10-20 |
| 1255459780 | Billy Lee Berry | Counselor | 332 3rd Ave, Jasper, IN 47546 | 2007-03-26 |
| 1285776294 | Gregory K. Gordon | Optometrist | 471 Us 231 S, Jasper, IN 47546 | 2007-02-13 |
| 1902951312 | Urology Specialists PC | Urology | 1950 St Charles Street, Suite 3, Jasper, IN 47546 | 2007-01-24 |
| 1568548501 | Ralph E Mehling | Pharmacist | #435 Us 231 S, Jasper, IN 47546 | 2006-10-31 |
| 1962585430 | Heart To Heart Hospice of Southwest Indiana LLC | Hospice Care, Community Based | 415 E 6th St, Jasper, IN 47546 | 2006-10-20 |
| 1245347137 | Roy Elliott Cecchi | Obstetrics & Gynecology | 613 Dorbett Street, Jasper, IN 47546 | 2006-08-24 |
| 1093828790 | Sleep Management Institute LLC | Internal Medicine | 3157 Villa Way, Jasper, IN 47546 | 2006-08-16 |
| Find all providers in zip 47546 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023440153 | Ridgewood Health Services, Inc. | Skilled Nursing Facility | 201 Oakhill Rd, Jasper, AL 35504-7496 | 2013-07-31 |
| 1962710079 | Sweet Neches Properties, Ltd. | Skilled Nursing Facility | 144 Bulldog Ave, Jasper, TX 75951-4949 | 2010-09-23 |
| 1235205816 | Adams County Memorial Hospital | Skilled Nursing Facility | 520 W 9th Street, Jasper, IN 47546-2711 | 2006-11-27 |
| 1134206030 | Good Samaritan Hospital | Skilled Nursing Facility | 3150 Saint Charles St, Jasper, IN 47546-1858 | 2006-11-01 |
| 1720002819 | Hamilton Health Enterprises, Inc. | Skilled Nursing Facility | 427 Nw 15th Ave, Jasper, FL 32052-5874 | 2006-07-26 |
| 1962435149 | Salem Housing Corporation | Skilled Nursing Facility | 315 W Gibson St, Jasper, TX 75951-4903 | 2006-07-09 |
| 1770530297 | Pruitthealth - Jasper, LLC | Skilled Nursing Facility | 1350 E Church St, Jasper, GA 30143-1910 | 2006-05-29 |
| 1487620498 | Grandview Health Care Center, Inc | Skilled Nursing Facility | 618 Gennett Dr, Jasper, GA 30143-1143 | 2006-02-28 |
| 1699764357 | Heritage House Health and Rehab Center | Skilled Nursing Facility | 2909 Howard Dr, Jasper, IN 47546-1113 | 2005-10-17 |
| 1073500831 | Shadescrest Health Care Center | Skilled Nursing Facility | 331 25th St W, Jasper, AL 35501-5828 | 2005-10-05 |
| Find all providers in JASPER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.