Brooke Grove Foundation, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

21-014 Issued in MD

Legal business name

BROOKE GROVE FOUNDATION, INC.

Doing business as

Williamsport Nursing Home

Practice address

154 N Artizan St
Williamsport, MD 21795-1104

Phone

(301) 924-2811

Fax

(301) 924-1200

NPI assigned

May 10, 2007

Last updated

Jan 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Keith Spillane

Title

Dir. of Corp. Finance

Phone

(301) 388-7204

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Williamsport Nursing Home Doing business as

Locations

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.

• Tejaswi Reddy Vootla, M.D.

  • Internal Medicine Physician
  • Berkeley Springs, WV
  • NPI 1164780011
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1215141973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18100 SLADE SCHOOL RD",
            "city": "SANDY SPRING",
            "state": "MD",
            "postal_code": "208601313",
            "telephone_number": "301-924-2811",
            "fax_number": "301-924-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 N ARTIZAN ST",
            "city": "WILLIAMSPORT",
            "state": "MD",
            "postal_code": "217951104",
            "telephone_number": "301-924-2811",
            "fax_number": "301-924-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKE GROVE FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "SPILLANE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "DIR. OF CORP. FINANCE",
        "authorized_official_telephone_number": "301-388-7204"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MD",
            "license": "21-014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21760760000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williamsport Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Williamsport Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Antietam Health Services (Home Care Pharmacy-Williamsport)
• Lucille Bantugan
• Samantha Biser, CRNP, PMHNP-BC
• Hillary Theresa Blank, CRNP
• Jonathan Boyer, PHARMD
• Amy Brown, MS, CCC-SLP
• Jessica Buchanan
• Kayle Buchanan
• Cara Nicole Burgan, PTA
• Kelsey Buterbaugh, COTA/L

• Skilled Nursing Facility in Williamsport, MD
• Providers in Williamsport, MD by specialty
• Skilled Nursing Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; 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.