Brookside Casa Isl

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

BROOKSIDE CASA ISL

Practice address

506 Bremond St
Versailles, MO 65084-1122

Phone

(573) 378-2462

Fax

(573) 378-2462

NPI assigned

Sep 4, 2007

Last updated

Sep 4, 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. Denise Lynn Spotila

Title

Owner

Phone

(573) 378-2462

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1740474600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 BREMOND ST",
            "city": "VERSAILLES",
            "state": "MO",
            "postal_code": "650841122",
            "telephone_number": "573-378-2462",
            "fax_number": "573-378-2462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 BREMOND ST",
            "city": "VERSAILLES",
            "state": "MO",
            "postal_code": "650841122",
            "telephone_number": "573-378-2462",
            "fax_number": "573-378-2462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE CASA ISL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-04",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "SPOTILA",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-378-2462",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sophia D Aycock, MS, PLPC
• Nicole C Bailey, RN
• Tyler Baumhoer, PTA
• Matthew Bell
• Renae M Belt, LMSW
• Madison Brown
• Jennifer Dawn Buckingham, FNP-C
• Diana Moree Burdick, FNP
• Susan Mary Burkhart, M.D.
• Leanne I Cain, RPH

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Versailles, MO
• Providers in Versailles, MO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 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.