BROOKSIDE MANOR NPI 1902008766

NPI Information

  • NPI: 1902008766
  • Provider Name: BROOKSIDE MANOR
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • CLIA Number: 26D2117374
  • Address: 2434 HIGHWAY H
    FARMINGTON, MO
    ZIP 63640
  • Phone: (573) 756-6434

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NPI Details

BROOKSIDE MANOR is an assisted living facility in Farmington, MO. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. BROOKSIDE MANOR NPI is 1902008766. The provider is registered as an organization entity type.

The provider's business location address is:

2434 HIGHWAY H
FARMINGTON, MO
ZIP 63640-033
Phone: (573) 756-6434
Fax: (573) 756-6434

The provider's authorized official is Julie Nicholson .
The authorized official title is OWNER OPERATOROperator and has the following contact phone number (573) 756-6434.

The CLIA number assigned to this NPI record is 26D2117374 - other - rcf with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/4/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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
1310400000XAssisted Living Facility033659MISSOURIYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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