Organization
BROOKSIDE MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LISA MIDDLETON (ADMINISTRATOR)
(618) 532-2428
Entity
Organization
Contact information
Practice address
1740 W MCCORD ST, CENTRALIA, IL 62801-5808
(618) 532-2428
(618) 532-8305
Mailing address
1740 W MCCORD ST, CENTRALIA, IL 62801-5808
(618) 532-2428
(618) 532-8305
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
00045096
IL
Other
Enumeration date
03/20/2007
Last updated
08/22/2020
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