# SCG MADILL BROOKSIDE LLC

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

## Provider details

- **NPI number:** 1699764100
- **Authorized official:** MR. KEVIN C GOYER JR. (PRESIDENT)
- **Authorized official phone:** (813) 341-2700

## Contact information

- **Practice address:** 310 BROOKSIDE DR, HIGHWAY 377, MADILL, OK 73446-9047
- **Practice address phone:** (580) 795-2100
- **Practice address fax:** (580) 677-9918
- **Mailing address:** 1240 MARBELLA PLAZA DR., TAMPA, FL 33619-7905
- **Mailing address phone:** (813) 341-2700
- **Mailing address fax:** (813) 676-0127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH4801-4801 | OK | Yes |

## Other

- **Enumeration date:** 10/18/2005
- **Last updated:** 07/17/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100776200A | — | OK |