Provider Demographics
NPI:1871676015
Name:SENIOR CARE GROUP LLC
Entity Type:Organization
Organization Name:SENIOR CARE GROUP LLC
Other - Org Name:BROOKSIDE REHABILITATION & CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:KMET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-682-9759
Mailing Address - Street 1:310 PENSACOLA RD
Mailing Address - Street 2:PO BOX 248
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-3318
Mailing Address - Country:US
Mailing Address - Phone:828-682-9759
Mailing Address - Fax:828-682-9825
Practice Address - Street 1:310 PENSACOLA RD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-3318
Practice Address - Country:US
Practice Address - Phone:828-682-9759
Practice Address - Fax:828-682-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0467314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415305Medicaid
NC3416489Medicaid
NC3416489Medicaid