BROOKS HOME I.V., INC. (BROOKS HEALTH CARE) - NPI NUMBER 1760417232

Summary

Provider Name: BROOKS HOME I.V., INC. (BROOKS HEALTH CARE)

NPI Number: 1760417232

Clasification: Clinic/Center (261QI0500X)

Specialization: Infusion Therapy

Address:
3410 W ASHLAN AVE
FRESNO, CA
ZIP 93722

Phone Number: (559) 221-4800



Detailed Information

BROOKS HOME I.V., INC. is an infusion therapy clinic/center in Fresno, CA. The assigned NPI number for this provider is 1760417232 and is registered as an organization entity type.
The provider Is Doing Business As Brooks Health Care.

The provider's business address is:

3410 W ASHLAN AVE
FRESNO, CA
ZIP 93722-440
Phone: (559) 221-4800
Fax: (559) 233-0227

The provider's authorized official is Kelly John Brooks .
The authorized official title is C.e.o. and has the following contact phone number (559) 221-4800.

The enumeration date for this NPI number is 7/12/2006 and was last updated on 11/19/2009.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QI0500X Clinic/Center Infusion Therapy PHY43496 CA No
2 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies 101409 CA No
3 3336H0001X Pharmacy Home Infusion Therapy Pharmacy PHY43496 CA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 PHA434960 MEDICAID CA
2 1218850001 MEDICARE NSC CA

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1760417232 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name BROOKS HOME I.V., INC. The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name BROOKS HEALTH CARE Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 3410 W ASHLAN AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name FRESNO The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name CA The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 937224440 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 5592214800 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 5592330227 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 7/12/2006 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 11/19/2009 The date that a record was last updated or changed.
16 Authorized Official Last Name BROOKS The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name KELLY The first name of the authorized official.
18 Authorized Official Middle Name JOHN The middle name of the authorized official.
19 Authorized Official Title or Position C.E.O. The title or position of the authorized official.
20 Authorized Official Telephone Number 5592214800 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 261QI0500X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Provider License Number 1 PHY43496 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
23 Provider License Number State Code 1 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
24 Healthcare Provider Primary Taxonomy Switch 1 N
25 Healthcare Provider Taxonomy Code 2 332BX2000X
26 Provider License Number 2 101409 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
27 Provider License Number State Code 2 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
28 Healthcare Provider Primary Taxonomy Switch 2 N
29 Healthcare Provider Taxonomy Code 3 3336H0001X
30 Provider License Number 3 PHY43496 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
31 Provider License Number State Code 3 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
32 Healthcare Provider Primary Taxonomy Switch 3 Y
33 Other Provider Identifier 1 PHA434960 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
35 Other Provider Identifier State 1 CA
36 Other Provider Identifier 2 1218850001 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier Type Code 2 07 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
38 Other Provider Identifier State 2 CA
39 Is Organization Subpart N
40 Authorized Official Name Prefix Text DR.
41 Authorized Official Credential Text PHARM D

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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