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Organization
BROOKSIDE NURSING HOME INC
Active
Organization
BROOKSIDE NURSING HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS E RICE SR. ADMINISTRATOR (PRESIDENT ADMINISTRATOR)
(802) 295-7511
Entity
Organization
Contact information
Practice address
1200 CHRISTIAN ST, WHITE RIVER JCT, VT 05001
(802) 295-7511
(802) 295-2533
Mailing address
1200 CHRISTIAN ST, WHITE RIVER JCT, VT 05001
(802) 295-7511
(802) 295-2533
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0270000136
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0475010
—
VT
01
—
4700718875
CLIA
—
Enumeration date
09/07/2005
Last updated
06/22/2015
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