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General NPI Number Information
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NPI Number | 1568301240
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Entity Type | Organization
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Legal Business Name | BROOKRIDGE ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 1713 BROOKRIDGE RD
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City | FRIENDSHIP
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State | WI
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Zip | 53934-9345
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Country | US
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Telephone | 608-814-8018
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Fax |
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Provider Business Mailing Address
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Address Line | 706 STONE ARCH WAY
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City | JORDAN
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State | MN
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Zip | 55352-6020
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Country | US
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Telephone | 608-814-8018
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHARMARKE HUSSAIN ALI
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Credential |
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Telephone | 608-814-8018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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