Provider Demographics
NPI:1134360118
Name:BROOKRIDGE ASSISTED LIVING
Entity type:Organization
Organization Name:BROOKRIDGE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDYTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-362-6266
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3138
Mailing Address - Country:US
Mailing Address - Phone:919-362-6266
Mailing Address - Fax:
Practice Address - Street 1:312 LYNCH ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2028
Practice Address - Country:US
Practice Address - Phone:919-362-6266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-092146310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility