MEDICARE: BROOKSIDE ADULT DAY HEALTH CARE, LLC

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
1	261QA0600X	Adult Day Care Clinic/Center	617	MO

General Provider Information

NPI Number	:	1639169915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKSIDE ADULT DAY HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	400 W 57TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-1230
Country	:	US
Telephone Number	:	816-926-9400
Fax Number	:	816-926-9300

Provider Business Practice Location Address
First Line	:	400 W 57TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-1230
Country	:	US
Telephone Number	:	816-926-9400
Fax Number	:	816-926-9300

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. CHRISTINE RUEBEL-MARSHALL
Credential	:	MSW
Telephone Number	:	816-926-9400

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/22/2020

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