NPI Code Detail JSON Logo

1457476640 NPI number — BROOKSIDE MANOR LLC

NPI Number: 1457476640
Health Care Provider/Practitioner: BROOKSIDE MANOR LLC

Information about “1457476640” NPI (BROOKSIDE MANOR LLC) exists in 1457476640 in HTML format HTML  |  1457476640 in plain Text format TXT  |  1457476640 in PDF (Portable Document Format) PDF  |  1457476640 in an XML format XML  formats.

NPI Number : 1457476640 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457476640",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BROOKSIDE MANOR LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1740 W MCCORD ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CENTRALIA",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62801-5808",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-532-2428",
    "MailingAddressFaxNumber": "618-532-8305",
    "FirstLinePracticeLocationAddress": "1740 W MCCORD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CENTRALIA",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62801-5808",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-532-2428",
    "PracticeLocationAddressFaxNumber": "618-532-8305",
    "EnumerationDate": "03/20/2007",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MIDDLETON",
    "AuthorizedOfficialFirstName": "LISA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": "MISS",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "618-532-2428",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "313M00000X",
        "TaxonomyName": "Nursing Facility/Intermediate Care Facility",
        "LicenseNumber": "00045096",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.