Brookside Nursing Home Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0270000136 Issued in VT

Legal business name

BROOKSIDE NURSING HOME INC

Practice address

1200 Christian St
White River JCT, VT 05001

Phone

(802) 295-7511

Fax

(802) 295-2533

NPI assigned

Sep 7, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Thomas E Rice Sr., ADMINISTRATOR

Title

President Administrator

Phone

(802) 295-7511

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Brookside Nursing and Rehabilitation Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Brookside Nursing and Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • White River Junction, VT
  • NPI 1548649932
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1013901917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CHRISTIAN ST",
            "city": "WHITE RIVER JCT",
            "state": "VT",
            "postal_code": "05001",
            "telephone_number": "802-295-7511",
            "fax_number": "802-295-2533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CHRISTIAN ST",
            "city": "WHITE RIVER JCT",
            "state": "VT",
            "postal_code": "05001",
            "telephone_number": "802-295-7511",
            "fax_number": "802-295-2533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE NURSING HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT ADMINISTRATOR",
        "authorized_official_telephone_number": "802-295-7511",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VT",
            "license": "0270000136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0475010",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "4700718875",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Grace Brennan, LMFT
• Lloyd Robert Bunten, RPH
• Caroline Margaret Craig, MSPT
• Laura Decapua, BA
• Crystal Irish, LADAC
• Erika Skyler Kardatzke, MA BCBA

• All providers in White River JCT, VT
• Skilled Nursing Facility in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.