Provider Demographics
NPI:1033687371
Name:BROOKDALE HOSPICE, LLC
Entity Type:Organization
Organization Name:BROOKDALE HOSPICE, LLC
Other - Org Name:BROOKDALE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, REGULATORY PRACTICES
Authorized Official - Prefix:
Authorized Official - First Name:DONNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-564-8181
Mailing Address - Street 1:111 WESTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5021
Mailing Address - Country:US
Mailing Address - Phone:615-564-8034
Mailing Address - Fax:
Practice Address - Street 1:29757 SW BOONES FERRY RD STE B
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7202
Practice Address - Country:US
Practice Address - Phone:503-570-9766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based