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NPI Code Detail

MEDICARE: BROOKSVILLE LESSEE LLC

MEDICARE: BROOKSVILLE LESSEE 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1649401324
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKSVILLE LESSEE LLC
Provider Business Mailing Address
First Line : 611 COMMERCE ST
Second Line : SUITE 3125
City : NASHVILLE
State : TN
Zip : 37203-3742
Country : US
Telephone Number : 615-255-0009
Fax Number : 615-242-1822
Provider Business Practice Location Address
First Line : 1114 CHATMAN BLVD
Second Line :
City : BROOKSVILLE
State : FL
Zip : 34601-3104
Country : US
Telephone Number : 352-796-6701
Fax Number : 352-796-6514
Authorized Official
Title or Position : PRESIDENT
Name : JAMES P. EARLE III
Credential :
Telephone Number : 615-255-0009
Provider Enumeration Date : 07/29/2009
Last Update Date : 07/29/2009

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Directions to “BROOKSVILLE LESSEE LLC ” Practice Location

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