BROOKSIDE MANOR (NPI# 1902008766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902008766 |
| Entity Type | Organization |
| Organization Name | BROOKSIDE MANOR |
| Practice Address |
2434 Highway H Farmington MO 63640-7033 |
| Practice Telephone | 5737566434 |
| Practice Fax Number | 5737566434 |
| Mailing Telephone | 5737566434 |
| Mailing Fax Number | 5737566434 |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JULIE NICHOLSON (OWNER OPERATOR) |
| Authorized Official Telephone | 5737566434 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 033659 | MO | Nursing & Custodial Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | BROOKSIDE MANOR | C/o David H. Comins, 116 High St., Manchester, CT 06040 |
| Oregon Corporations, Companies and Business Names | BROOKSIDE MANOR APARTMENTS | 1807 Nw 210th Circle, Ridgefield, WA 98642 |
| Virginia Business Entities | BROOKSIDE MANOR HOMEOWNERS ASSOICATION INC. | 2056 Stepanie Marie Dr, Falls Church, Virginia 22043 |
| System for Award Management (SAM) Entities | BROOKSIDE MANOR RESIDENCE | 804 Benson Rd Ste 100, Montevideo, MN 56265-1379 |
| Massachusetts Corporations | BROOKSIDE MANOR, INC. | 51 Miller Stile Rd., Quincy, MA 02169 |
| Massachusetts Corporations | BROOKSIDE MANOR, LLC | 51 Miller Stile Rd., Quincy, MA 02169 |
| Street Address |
2434 HIGHWAY H |
| City | FARMINGTON |
| State | MO |
| Zip Code | 63640-7033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275713638 | Brookside Manor Residential Care, LLC | Assisted Living Facility | 2434 Highway H, Farmington, MO 63640-7033 | 2007-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545254 | Brenda S Halton | Nurse Practitioner | 1010 West Columbia Street, Farmington, MO 63640 | 2020-10-13 |
| 1619519089 | Stacey Nicole Gillette | Counselor | 17885 Hart Pinkston Rd, Farmington, MO 63640 | 2019-10-17 |
| 1346890696 | Christopher Ryan Massey | Social Worker | 607 Pine St., Farmington, MO 63640 | 2019-09-18 |
| 1457909376 | Clarice Ogden | Social Worker | 203 South Washington Street, Farmington, MO 63640 | 2019-09-04 |
| 1861979718 | Clint Thebeau | In Home Supportive Care | 1276 W Liberty St, Farmington, MO 63640 | 2018-07-24 |
| 1023500600 | Lynn Machelle Knox | Counselor | 219 W Columbia St, Farmington, MO 63640 | 2018-05-31 |
| 1235620576 | Kim Bazzell | Registered Nurse | 1565 Ste. Genevieve Ave., Farmington, MO 63640 | 2018-05-22 |
| 1164919742 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | 774 Market St, Farmington, MO 63640 | 2018-04-18 |
| 1184127813 | Michelle Lynette Corvallis | Chiropractor | 17 South Franklin St., Farmington, MO 63640 | 2018-03-08 |
| 1992206213 | Farmington Vision Care LLC | Optometrist | 110 E Harrison St, Farmington, MO 63640 | 2018-02-22 |
| Find all providers in zip 63640 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427539600 | Peachtree Village of Farmington, LLC | Assisted Living Facility | 55 W Rainsong St, Farmington, AR 72730-8635 | 2018-08-24 |
| 1235628934 | Woodlands Senior Living of Farmington, LLC | Assisted Living Facility | 175 Knowlton Corner Rd, Farmington, ME 04938-6200 | 2018-05-08 |
| 1619238227 | Americare At Maplebrook Assisted Living, LLC | Assisted Living Facility | 520 Maple Valley Drive, Farmington, MO 63640 | 2012-05-31 |
| 1194050195 | New Communities, Inc. | Assisted Living Facility | 136 Rosewood Drive, Farmington, ME 04938 | 2009-10-08 |
| 1790932648 | Arden Courts of Farmington Ct LLC | Assisted Living Facility | 45 South Rd, Farmington, CT 06032-2022 | 2008-08-22 |
| 1356539696 | Harris Care Centers, Inc. | Assisted Living Facility | 208 W Columbia St, Farmington, MO 63640-1705 | 2007-10-11 |
| 1447448782 | Harris Care Centers, Inc | Assisted Living Facility | 508 N Washington St, Farmington, MO 63640-1756 | 2007-10-11 |
| 1356538458 | Harris Care Centers, Inc | Assisted Living Facility | 401 S Henry St, Farmington, MO 63640-1823 | 2007-10-02 |
| 1639234578 | Country Care Lc | Assisted Living Facility | 513 S 950 W, Farmington, UT 84025-4723 | 2006-12-22 |
| 1962564815 | Country Care LLC | Assisted Living Facility | 533 S 950 W, Farmington, UT 84025-4723 | 2006-12-15 |
| Find all providers in FARMINGTON | ||||
| City | FARMINGTON |
| Zip Code | 63640 |
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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.