Healthcare Provider Details

I. General information

NPI: 1639169915
Provider Name (Legal Business Name): BROOKSIDE ADULT DAY HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 57TH ST
KANSAS CITY MO
64113-1230
US

IV. Provider business mailing address

400 W 57TH ST
KANSAS CITY MO
64113-1230
US

V. Phone/Fax

Practice location:
  • Phone: 816-926-9400
  • Fax: 816-926-9300
Mailing address:
  • Phone: 816-926-9400
  • Fax: 816-926-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number617
License Number StateMO

VIII. Authorized Official

Name: MS. CHRISTINE RUEBEL-MARSHALL
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 816-926-9400