Organization
BROOKSIDE MANOR RESIDENTIAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STARLA KAY DULWORTH (ADMINISTRATOR/OWNER)
(573) 756-6434
Entity
Organization
Contact information
Practice address
2434 HIGHWAY H, FARMINGTON, MO 63640-7033
(573) 756-6434
(573) 756-6434
Mailing address
2434 HIGHWAY H, FARMINGTON, MO 63640-7033
(573) 756-6434
(573) 756-6434
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
034901
MO
Other
Enumeration date
11/13/2007
Last updated
11/13/2007
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