Healthcare Provider Details

I. General information

NPI: 1790758423
Provider Name (Legal Business Name): BROOKVILLE ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COUNTRY LN
BROOKVILLE OH
45309-9269
US

IV. Provider business mailing address

1 COUNTRY LN
BROOKVILLE OH
45309-9268
US

V. Phone/Fax

Practice location:
  • Phone: 937-833-2133
  • Fax:
Mailing address:
  • Phone: 937-833-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4590
License Number StateOH

VIII. Authorized Official

Name: TERRY J MILLER
Title or Position: OWNER/BOARD MEMBER
Credential:
Phone: 937-477-0985