Provider Demographics
NPI:1134326911
Name:BROOKRIDGE INC
Entity Type:Organization
Organization Name:BROOKRIDGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOSN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-536-9700
Mailing Address - Street 1:7802 NW QUANAH PARKER TRAILWAY
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505
Mailing Address - Country:US
Mailing Address - Phone:580-536-9700
Mailing Address - Fax:580-536-7954
Practice Address - Street 1:7802 NW QUANAH PARKER TRAILWAY
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-536-9700
Practice Address - Fax:580-536-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care