Brookside Village, Inc

LBN: Brookside Village, Inc
Brookside Village, Inc is an health care organization with primary practice located at 1111 Church Ave , Jasper IN 47546-3761. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Skilled Nursing Facility, which is considered as the primary health care specialty. Brookside Village, Inc can be contacted via phone (812) 634-7750, or through Moore, Stephen G. via phone (812) 332-2265.

Contact Information

Primary practice address
1111 Church Ave Jasper IN 47546-3761
Phone: (812) 634-7750
Fax: (812) 634-7751
Website:
Map and Directions
Authorized official contact:
Name: Moore, Stephen G. Doctor of Medicine (MD)
Phone: (812) 332-2265

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 050032401 Indiana

Profile Details

NPI number 1265419428
LBN Legal business name Brookside Village, Inc
DBA Doing business as
Authorized official Moore, Stephen G. Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 29th, 2005
Last updated Mar 20th, 2017 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265419428 NPPES
Indiana MEDICAID 201274720A

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