Organization
SCG MADILL BROOKSIDE LLC
Active
Other names
Brookside Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN C GOYER JR. (PRESIDENT)
(813) 341-2700
Entity
Organization
Contact information
Practice address
310 BROOKSIDE DR, HIGHWAY 377, MADILL, OK 73446-9047
(580) 795-2100
(580) 677-9918
Mailing address
1240 MARBELLA PLAZA DR., TAMPA, FL 33619-7905
(813) 341-2700
(813) 676-0127
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH4801-4801
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100776200A
—
OK
Enumeration date
10/18/2005
Last updated
07/17/2014
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