Provider Demographics
NPI:1740586874
Name:BROOKSHIRE INC
Entity Type:Organization
Organization Name:BROOKSHIRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:PURIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-334-6234
Mailing Address - Street 1:410 N HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4157
Mailing Address - Country:US
Mailing Address - Phone:801-334-6234
Mailing Address - Fax:801-605-5634
Practice Address - Street 1:410 N HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-4157
Practice Address - Country:US
Practice Address - Phone:801-334-6234
Practice Address - Fax:801-605-5634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT16541253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency