Provider Demographics
NPI:1790072858
Name:THE BROOKE EARL CARE FOUNDATION
Entity Type:Organization
Organization Name:THE BROOKE EARL CARE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:EARL
Authorized Official - Suffix:
Authorized Official - Credentials:PCT
Authorized Official - Phone:252-212-8132
Mailing Address - Street 1:1219 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-4545
Mailing Address - Country:US
Mailing Address - Phone:252-212-8132
Mailing Address - Fax:252-212-8132
Practice Address - Street 1:1219 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-4545
Practice Address - Country:US
Practice Address - Phone:252-212-8132
Practice Address - Fax:252-212-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCIP001700002224253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care