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

Organization subpart

No

Name

Ms. Starla Kay Dulworth

Title

Administrator/Owner

Phone

(573) 756-6434

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 13, 2007.

{
    "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

• All providers in Farmington, MO
• 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.