Provider Demographics
NPI:1134878416
Name:BROOKESIDE HEALTH LLC
Entity type:Organization
Organization Name:BROOKESIDE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-730-4210
Mailing Address - Street 1:1521 N COOPER ST STE 227
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5523
Mailing Address - Country:US
Mailing Address - Phone:817-656-4180
Mailing Address - Fax:682-277-4397
Practice Address - Street 1:1521 N COOPER ST STE 227
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5523
Practice Address - Country:US
Practice Address - Phone:817-656-4180
Practice Address - Fax:682-277-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies