Basic Information
| Provider Information | |||||||||
| NPI: | 1023391281 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOKSIDE HEALTHCARE & REHAB, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BROOKSIDE HEALTH AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4704 HIXSON PIKE | ||||||||
| Address2: | |||||||||
| City: | HIXSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373434840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238772024 | ||||||||
| FaxNumber: | 4238772328 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 BROOKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722051644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012243940 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2011 | ||||||||
| LastUpdateDate: | 07/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4238772024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.