Provider Demographics
NPI:1972190791
Name:BROOKS SUPPORTED LIVING, INC.
Entity Type:Organization
Organization Name:BROOKS SUPPORTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PERFECT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-861-1514
Mailing Address - Street 1:675 BROOK HOLW
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6259
Mailing Address - Country:US
Mailing Address - Phone:614-861-1514
Mailing Address - Fax:614-861-8198
Practice Address - Street 1:675 BROOK HOLW
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6259
Practice Address - Country:US
Practice Address - Phone:614-861-1514
Practice Address - Fax:614-861-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care