Provider Demographics
NPI:1023720760
Name:BROOKRIDGE LLC
Entity type:Organization
Organization Name:BROOKRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:DESVARIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-632-4045
Mailing Address - Street 1:18501 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6841
Mailing Address - Country:US
Mailing Address - Phone:216-848-9588
Mailing Address - Fax:
Practice Address - Street 1:18501 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6841
Practice Address - Country:US
Practice Address - Phone:216-848-9588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health