Brookside Manor Residential Care, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

034901 Issued in MO

Legal business name

BROOKSIDE MANOR RESIDENTIAL CARE, LLC

Practice address

2434 Highway H
Farmington, MO 63640-7033

Phone

(573) 756-6434

Fax

(573) 756-6434

NPI assigned

Nov 13, 2007

Last updated

Nov 13, 2007By 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

Ms. Starla Kay Dulworth

Title

Administrator/Owner

Phone

(573) 756-6434

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1275713638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2434 HIGHWAY H",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636407033",
            "telephone_number": "573-756-6434",
            "fax_number": "573-756-6434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2434 HIGHWAY H",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636407033",
            "telephone_number": "573-756-6434",
            "fax_number": "573-756-6434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE MANOR RESIDENTIAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "DULWORTH",
        "authorized_official_first_name": "STARLA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "573-756-6434",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "034901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridge of Hope
• Kaila Marie Bridges, FNP
• Ashley Meagan Brinkley
• Alexis Brooks
• Brookside Manor
• Margaret J Brothers, RN, CS
• Kelly Jeanne Brotherton, LPC
• Janet M Brown, BC-HIS
• Jennifer Brown
• Nicole Brown

• Assisted Living Facility in Farmington, MO
• Providers in Farmington, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.