Southlake Educational Center

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

1013303 Issued in TX

Legal business name

SOUTHLAKE EDUCATIONAL CENTER

Doing business as

Brookwood II

Practice address

649 Circle View South
Hurst, TX 76054-3316

Phone

(817) 481-5368

Fax

(817) 251-0318

NPI assigned

Aug 1, 2007

Last updated

Aug 1, 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

Michelle Deanne Neal

Title

Admin/Assistant QMRP

Phone

(817) 481-5368

Specialties & licenses 1

Addresses

Other names 1

• BROOKWOOD II Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356531644. Details of each certification follow.

• CCN 45G953 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 45G953

Legal name

BROOKWOOD II

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jun 22, 1992

Last certification

May 30, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

649 Circle View S
Hurst, TX 76054

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

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185926400000",
    "number": "1356531644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 LONESOME DOVE RD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760923223",
            "telephone_number": "817-481-5368",
            "fax_number": "817-251-0318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "649 CIRCLE VIEW SOUTH",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760543316",
            "telephone_number": "817-481-5368",
            "fax_number": "817-251-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE EDUCATIONAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-01",
        "last_updated": "2007-08-01",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "DEANNE",
        "authorized_official_title_or_position": "ADMIN/ASSISTANT QMRP",
        "authorized_official_telephone_number": "817-481-5368"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TX",
            "license": "1013303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROOKWOOD II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zarah Caberte Smith
• Megan Mackenzie Solis, OD
• Johannah Song, LPC
• Megan Sordini, M.S. CCC-SLP
• Soumava Sen, DDS, P.C.
• Southwest Hyperbarics
• Southwest Medical Equipment, Inc
• Phillip Skot Spears, RD, RDN
• Jordan Ashley Spencer
• Katherine P Squires

• Intellectual Disabilities Intermediate Care Facility in Hurst, TX
• Providers in Hurst, TX by specialty
• Intellectual Disabilities Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.