Basic Information
| Provider Information | |||||||||
| NPI: | 1649454943 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOKDALE HOME HEALTH LLC | ||||||||
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| OtherOrganizationName: | BROOKDALE HOME HEALTH LAKELAND | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 WESTWOOD PL | ||||||||
| Address2: | STE 400 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152212250 | ||||||||
| FaxNumber: | 6152212280 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 E PINE ST | ||||||||
| Address2: | STE 5 | ||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338014982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636838249 | ||||||||
| FaxNumber: | 8636882939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2007 | ||||||||
| LastUpdateDate: | 06/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | MCGLASSON | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR DIRECTOR REGULATORY PRACTICES | ||||||||
| AuthorizedOfficialTelephone: | 6152212250 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 299991576 | FL | Y | Agencies | Home Health |
No ID Information.