Healthcare Provider Details

I. General information

NPI: 1265430938
Provider Name (Legal Business Name): BROOKSHIRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEADOWLAND DR
HILLSBOROUGH NC
27278-8502
US

IV. Provider business mailing address

PO BOX 1107
HILLSBOROUGH NC
27278-1107
US

V. Phone/Fax

Practice location:
  • Phone: 919-644-6714
  • Fax: 919-644-0812
Mailing address:
  • Phone: 919-644-6714
  • Fax: 919-644-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0545
License Number StateNC

VIII. Authorized Official

Name: MRS. BETTY BUTLER STEVENS
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 919-644-6714