Brookside Lving Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NCF-627 Issued in SC

Legal business name

BROOKSIDE LVING CENTER, LLC

Practice address

208 James St
Anderson, SC 29625-2942

Phone

(864) 226-3427

Fax

(864) 226-7215

NPI assigned

Jul 15, 2006

Organization subpart

No

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

Authorized official

Name

Mr. John F. Swift

Title

VP & Cfo

Phone

(864) 269-3725

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205107200000",
    "number": "1548286032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 GRACE DR",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296409088",
            "telephone_number": "864-269-3725",
            "fax_number": "864-295-3383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 JAMES ST",
            "city": "ANDERSON",
            "state": "SC",
            "postal_code": "296252942",
            "telephone_number": "864-226-3427",
            "fax_number": "864-226-7215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE LVING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2008-03-10",
        "status": "A",
        "authorized_official_last_name": "SWIFT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "VP & CFO",
        "authorized_official_telephone_number": "864-269-3725",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SC",
            "license": "NCF-627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0627 NH",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Brock, M.ED
• Tabitha Dawn Brock
• Bailey Brockelbank, MS, RDN, LD
• Hannah Marie Brooks, FNP-BC
• Ronald Jerry Brookshire Jr., ADN RN
• Camille Hutchins Broom, LPC
• Broome Health Services, Inc.
• Joseph Kevin Broome, D.C.
• Anthony Jerome Brown
• Caroline Pruitt Brown, PA

• Skilled Nursing Facility in Anderson, SC
• Providers in Anderson, SC by specialty
• Skilled Nursing Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2008; 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.