Provider Demographics
NPI:1093739617
Name:BRENTWOOD FAMILY CARE CENTER, INC.
Entity type:Organization
Organization Name:BRENTWOOD FAMILY CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLFE-SIDBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-370-8080
Mailing Address - Street 1:4880 BIG ISLAND DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7490
Mailing Address - Country:US
Mailing Address - Phone:904-750-6863
Mailing Address - Fax:
Practice Address - Street 1:4880 BIG ISLAND DR UNIT 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7490
Practice Address - Country:US
Practice Address - Phone:904-750-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30315311Medicare PIN
TN3703773Medicare ID - Type UnspecifiedGROUP ID NUMBER