# CAMELOT BROOKSIDE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Camelot Brookside
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689943078
- **Authorized official:** NICOLE HOWARD (C.O.O.)
- **Authorized official phone:** (318) 445-6470

## Contact information

- **Practice address:** 3330 N FRONTAGE RD, JENNINGS, LA 70546-3269
- **Practice address phone:** (337) 824-2466
- **Mailing address:** 4333 SHREVEPORT HWY, PINEVILLE, LA 71360-3828
- **Mailing address phone:** (318) 445-6470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | Yes |
| 314000000X | Skilled Nursing Facility | — | NULL | — |

## Other

- **Enumeration date:** 12/14/2011
- **Last updated:** 12/14/2011