Russell-Smith Holdings, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

RUSSELL-SMITH HOLDINGS, INC.

Doing business as

Brookside Extended Care

Practice address

780 Snider Rd
Mason, OH 45040-1309

Phone

(513) 398-1020

NPI assigned

Nov 18, 2024

Organization subpart

No

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

Authorized official

Name

Sandy Muir

Title

VP of Government Affairs

Phone

(440) 793-2245

Specialties & licenses 1

Addresses

Other names 1

• BROOKSIDE EXTENDED CARE Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134944861. Details of each certification follow.

• CCN 36G073 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G073

Legal name

BROOKSIDE EXTENDED CARE CENTER

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Apr 15, 1981

Last certification

May 1, 2024

Beds

92

Ownership / control type

Private (proprietary)

Facility address

780 Snider Road
Mason, OH 45040

Tax ID family

Affinity Place Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Russell-Smith Holdings, Inc.

  dba Affinity Place Home

  • Intellectual Disabilities Intermediate Care Facility
  • Mount Healthy, OH
  • NPI 1174487748
  NPD tax ID
• Russell-Smith Holdings, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Cincinnati, OH
  • NPI 1528922192
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Manish Srivastava, MD

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Cincinnati, OH
  • NPI 1538283627
  NPD (past)

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

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1134944861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 SNIDER RD",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450401309",
            "telephone_number": "513-398-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 SNIDER RD",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450401309",
            "telephone_number": "513-398-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL-SMITH HOLDINGS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "MUIR",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "VP OF GOVERNMENT AFFAIRS",
        "authorized_official_telephone_number": "440-793-2245"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROOKSIDE EXTENDED CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kevin Armando Ruiz
• Grace Nicole Runge
• Joshua Allen Runtenelli, MSW, LISW, LICDC
• Michelle N Ruoss, APRN, PMHNP-BC
• Rima N Rusnak, M.D.
• Erin Rachelle Russell, MSN, FNP-BC
• Jena Rutter
• Richard M Rutz, CNP
• Rudo Rwizi, RBT
• Ryan Macks, LLC

• Intellectual Disabilities Intermediate Care Facility in Mason, OH
• Providers in Mason, OH by specialty
• Intellectual Disabilities Intermediate Care Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.