Brookside Skilled Nursing

LBN: St Johns Volunteers
Brookside Skilled Nursing is an health care organization with primary practice located at 2620 Flores St , San Mateo CA 94403-2320. The organization recently has 4 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Skilled Nursing Facility, Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Nursing Facility Supplies, Suppliers / Parenteral & Enteral Nutrition. Nursing & Custodial Care Facilities / Skilled Nursing Facility is the primary health care specialty. St Johns Volunteers can be contacted via phone (650) 349-2161, or through Grimes, Jeremy E via phone (925) 855-0881.

Contact Information

Primary practice address
2620 Flores St San Mateo CA 94403-2320
Phone: (650) 349-2161
Fax: (650) 349-4510
Website:
Map and Directions
Authorized official contact:
Name: Grimes, Jeremy E
Phone: (925) 855-0881

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 220000171 California
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X 220000171 California
Suppliers / Nursing Facility Supplies 332BN1400X 220000171 California
Suppliers / Parenteral & Enteral Nutrition 332BP3500X 220000171 California

Profile Details

NPI number 1952393076
LBN Legal business name St Johns Volunteers
DBA Doing business as Brookside Skilled Nursing
Authorized official Grimes, Jeremy E
Entity Organization
Organization subpart 1 No
Enumeration date Aug 16th, 2005
Last updated Jun 23rd, 2011 - about 15 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 1952393076 NPPES
California MEDICAID ZZR05188G

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