Provider Demographics
NPI:1023605995
Name:BROOKSIDE GUIDES, INC.
Entity type:Organization
Organization Name:BROOKSIDE GUIDES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:STARR
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-215-4234
Mailing Address - Street 1:25 TACOMA PL
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1629
Mailing Address - Country:US
Mailing Address - Phone:828-215-4234
Mailing Address - Fax:
Practice Address - Street 1:239 S FRENCH BROAD AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3901
Practice Address - Country:US
Practice Address - Phone:828-215-4234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty