Provider Demographics
NPI:1467654129
Name:JUNNIE BROOKS
Entity Type:Organization
Organization Name:JUNNIE BROOKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:606-464-3348
Mailing Address - Street 1:165 GOSNEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-9735
Mailing Address - Country:US
Mailing Address - Phone:606-662-6450
Mailing Address - Fax:
Practice Address - Street 1:165 GOSNEYVILLE RD
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-9735
Practice Address - Country:US
Practice Address - Phone:606-662-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000000000251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherSOCIAL SECURITY