Provider Demographics
NPI:1164869863
Name:BROOKWOOD HEALTHCARE SYSTEMS, LLC
Entity Type:Organization
Organization Name:BROOKWOOD HEALTHCARE SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEMETA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CMC
Authorized Official - Phone:866-616-9334
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-0321
Mailing Address - Country:US
Mailing Address - Phone:866-616-9334
Mailing Address - Fax:972-230-1390
Practice Address - Street 1:1805 WYLIE CREEK DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-1729
Practice Address - Country:US
Practice Address - Phone:866-616-9334
Practice Address - Fax:972-230-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty