Provider Demographics
NPI:1265430938
Name:BROOKSHIRE INC
Entity type:Organization
Organization Name:BROOKSHIRE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:BUTLER
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:919-644-6714
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-1107
Mailing Address - Country:US
Mailing Address - Phone:919-644-6714
Mailing Address - Fax:919-644-0812
Practice Address - Street 1:300 MEADOWLAND DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8502
Practice Address - Country:US
Practice Address - Phone:919-644-6714
Practice Address - Fax:919-644-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0545314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3425439Medicaid
NC345439Medicare Oscar/Certification