Brookwood Group Home

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

Legal business name

BROOKWOOD GROUP HOME

Practice address

RR 1 Box 1560
Cross Timbers, MO 65634-9721

Phone

(417) 998-6502

Fax

(417) 722-4417

NPI assigned

Mar 20, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Gary D Boggs

Title

President

Phone

(417) 722-4416

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164547949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 HOPPER TRL",
            "city": "URBANA",
            "state": "MO",
            "postal_code": "657679234",
            "telephone_number": "417-722-4416",
            "fax_number": "417-722-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 1 BOX 1560",
            "city": "CROSS TIMBERS",
            "state": "MO",
            "postal_code": "656349721",
            "telephone_number": "417-998-6502",
            "fax_number": "417-722-4417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKWOOD GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOGGS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-722-4416",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Benedict, PA-C
• Builtright Home Modifications L.L.C
• Ozark Mountain Medical LLC
• Renewed Health Solutions LLC

• All providers in Cross Timbers, MO
• Mental Illness Intermediate Care Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.