Provider Demographics
NPI:1346803525
Name:BROOKSTONE FOUNDATION
Entity Type:Organization
Organization Name:BROOKSTONE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:TIPPETTS
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:435-767-8410
Mailing Address - Street 1:198 N 100 E
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2831
Mailing Address - Country:US
Mailing Address - Phone:435-767-8410
Mailing Address - Fax:
Practice Address - Street 1:198 N 100 E # 198N100E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2831
Practice Address - Country:US
Practice Address - Phone:435-628-1111
Practice Address - Fax:435-652-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility