Provider Demographics
NPI:1255817466
Name:BROOKS GLOBAL INCORPORATED
Entity type:Organization
Organization Name:BROOKS GLOBAL INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:702-743-1999
Mailing Address - Street 1:5817 MAGIC OAK ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-6884
Mailing Address - Country:US
Mailing Address - Phone:702-743-1999
Mailing Address - Fax:
Practice Address - Street 1:5817 MAGIC OAK ST
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-6884
Practice Address - Country:US
Practice Address - Phone:702-743-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20181495070251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20181495070Medicaid