Provider Demographics
NPI:1245801646
Name:BROOKSVILLE ASSISTED LIVING HOME INC.
Entity Type:Organization
Organization Name:BROOKSVILLE ASSISTED LIVING HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-738-4866
Mailing Address - Street 1:55 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39739-2004
Mailing Address - Country:US
Mailing Address - Phone:662-738-4866
Mailing Address - Fax:
Practice Address - Street 1:55 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39739-2004
Practice Address - Country:US
Practice Address - Phone:662-738-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility