Provider Demographics
NPI:1124029053
Name:BSMC LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:BSMC LIMITED LIABILITY COMPANY
Other - Org Name:BROOKSIDE INN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-688-2500
Mailing Address - Street 1:1297 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1977
Mailing Address - Country:US
Mailing Address - Phone:303-688-2500
Mailing Address - Fax:303-688-2600
Practice Address - Street 1:1297 S PERRY ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1977
Practice Address - Country:US
Practice Address - Phone:303-688-2500
Practice Address - Fax:303-688-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0380314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05652813Medicaid
CO05652813Medicaid