Provider Demographics
NPI:1891722187
Name:BROSIS MANAGEMENT OF CATAWBA COUNTY
Entity type:Organization
Organization Name:BROSIS MANAGEMENT OF CATAWBA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SHERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-695-8282
Mailing Address - Street 1:P.O. BOX 1718
Mailing Address - Street 2:920 4TH STREET SW
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9679
Mailing Address - Country:US
Mailing Address - Phone:828-695-8282
Mailing Address - Fax:828-695-8218
Practice Address - Street 1:920 4TH STREET SW
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9679
Practice Address - Country:US
Practice Address - Phone:828-695-8282
Practice Address - Fax:828-695-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0603314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405516Medicaid
NC340613UMedicaid
NC3405516Medicaid
NC345516Medicare UPIN