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General NPI Number Information
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NPI Number | 1134878416
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Entity Type | Organization
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Legal Business Name | BROOKESIDE HEALTH LLC
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 1521 N COOPER ST STE 227
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City | ARLINGTON
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State | TX
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Zip | 76011-5523
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Country | US
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Telephone | 817-656-4180
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Fax | 682-277-4397
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Provider Business Mailing Address
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Address Line | 1521 N COOPER ST STE 227
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City | ARLINGTON
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State | TX
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Zip | 76011-5523
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Country | US
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Telephone | 817-656-4180
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Fax | 682-277-4397
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Authorized Official
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Title or Position | PRESIDENT
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Name | COLIN NICKERSON
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Credential |
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Telephone | 224-730-4210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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