SL Glenbrooke LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11650 Issued in FL

Legal business name

SL GLENBROOKE LLC

Practice address

815 Briar Creek Blvd NE
Palm Bay, FL 32905-5423

Phone

(321) 956-3330

Fax

(321) 956-3998

NPI assigned

Mar 27, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Charlotte Willis, LCSW

Title

Executive Director

Phone

(321) 956-3330

Specialties & licenses 1

Addresses

Other names 1

• Glenbrooke at Palm Bay Doing business as

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364342400000",
    "number": "1144563222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 BRIAR CREEK BLVD NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055423",
            "telephone_number": "321-956-3330",
            "fax_number": "321-956-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 BRIAR CREEK BLVD NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329055423",
            "telephone_number": "321-956-3330",
            "fax_number": "321-956-3998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SL GLENBROOKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-27",
        "last_updated": "2013-03-27",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "321-956-3330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenbrooke at Palm Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Clifton Simeus
• Ivette Simpson, APRN-FNP
• Charmaine Singh
• Jessica Singh
• Ravinder H. Singh, MD
• Beverly Jean Smith
• Delia A. Smith, M.D.
• Erin Eileen Smith, MA-CCC-SLP
• Heidi Smith
• Judy Ann Smith

• Assisted Living Facility in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; 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.