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General NPI Number Information
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NPI Number | 1265430938
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Entity Type | Organization
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Legal Business Name | BROOKSHIRE INC
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 300 MEADOWLAND DR
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-8502
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Country | US
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Telephone | 919-644-6714
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Fax | 919-644-0812
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Provider Business Mailing Address
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Address Line | PO BOX 1107
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-1107
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Country | US
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Telephone | 919-644-6714
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Fax | 919-644-0812
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BETTY BUTLER STEVENS
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Credential | LNHA
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Telephone | 919-644-6714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0545
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License Number State | NC
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