Provider Demographics
NPI:1487948576
Name:BROOKS & ASSOCIATES YOUTH AND FAMILY SERVICES, LL
Entity type:Organization
Organization Name:BROOKS & ASSOCIATES YOUTH AND FAMILY SERVICES, LL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-755-2011
Mailing Address - Street 1:4450 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4450
Mailing Address - Country:US
Mailing Address - Phone:910-755-2011
Mailing Address - Fax:
Practice Address - Street 1:4450 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4450
Practice Address - Country:US
Practice Address - Phone:910-755-2011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCEANIC INFINITE CAP SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3931251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418622Medicaid