Provider Demographics
NPI:1578695698
Name:BROOKSFAMILYCAREHOMES
Entity Type:Organization
Organization Name:BROOKSFAMILYCAREHOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHINNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-480-9202
Mailing Address - Street 1:117 FOXHILL DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28150-9065
Mailing Address - Country:US
Mailing Address - Phone:704-480-9202
Mailing Address - Fax:
Practice Address - Street 1:117 FOXHILL DR
Practice Address - Street 2:
Practice Address - City:KINGSTOWN
Practice Address - State:NC
Practice Address - Zip Code:28150-9065
Practice Address - Country:US
Practice Address - Phone:704-480-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-023-024261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802114OtherPROVIDER