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NPI Code Detail

MEDICARE: BROOK VIEW NURSING HOME, INC.

MEDICARE: BROOK VIEW NURSING HOME, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityMO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366449811
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOK VIEW NURSING HOME, INC.
Provider Business Mailing Address
First Line : 2963 DODDRIDGE AVE
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-1736
Country : US
Telephone Number : 636-477-3280
Fax Number : 636-477-3241
Provider Business Practice Location Address
First Line : 2963 DODDRIDGE AVE
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-1736
Country : US
Telephone Number : 314-291-4557
Fax Number : 314-291-8548
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MR. MARK LIERMAN
Credential :
Telephone Number : 636-477-3280
Provider Enumeration Date : 06/30/2005
Last Update Date : 12/01/2020

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Directions to “BROOK VIEW NURSING HOME, INC. ” Practice Location

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