BROOKSIDE VILLAGE, INC
NPI 1265419428
Skilled Nursing Facility in Jasper, IN

Active since December 29, 2005CLIA 15D0999958 · Waiver
4/5
Overall Rating
1111 CHURCH AVE, JASPER, IN 47546(812) 634-7750(812) 634-7751 Get Directions Write a Review

NPPES record last updated: March 20, 2017. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Brookside Village, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROOKSIDE VILLAGE, INC (NPI 1265419428) is a healthcare organization registered as a skilled nursing facility in Jasper, Indiana and active in the NPI registry since December 2005. The organization holds a CLIA Waiver certificate valid through May 28, 2028 and lists Stephen G. Moore, President/ceo, as its authorized official.

NPPES Registry Identity

NPI1265419428
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameBROOKSIDE VILLAGE, INC
Location Address1111 CHURCH AVEJasper, IN 47546-3761
Mailing Address2749 E Covenanter DrBloomington, IN 47401-5454 · (812) 332-2265 · Fax (812) 334-0853
Fax(812) 634-7751
Organization SubpartNo
Authorized OfficialStephen G. MoorePresident/ceo · (812) 332-2265
Enumeration DateDecember 29, 2005
Last NPPES UpdateMarch 20, 2017
NPI 1265419428 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in IN · 050032401
Definition

(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

1111 CHURCH AVE, Jasper, IN 47546

Other Identifiers 2

Medicaid201274720AIN
Medicare OSCAR/certification155703IN

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D0999958

Brookside Village Health & Living Center · Jasper, IN
Active · expires May 28, 2028
CLIA Number15D0999958
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateMay 29, 2026
Certificate Expiration DateMay 28, 2028
Laboratory DirectorKailene Allison
Laboratory Phone(812) 634-7750
Laboratory LocationBrookside Village Health & Living Center1111 Church Avenue, Jasper, IN 47546
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Nursing Home Quality Ratings CMS Care Compare

Quality ratings, staffing and inspection history for Brookside Village Inc (CMS certification number 155703), from CMS Care Compare.

Brookside Village Inc

Nursing home · Jasper, IN
4/5 CMS Overall Rating
OwnershipFor profit - Corporation
CMS Certification Number155703
Certified Beds27 beds24 residents per day on average
Medicare & Medicaid Participant SinceJuly 25, 2002
Resident & Family CouncilResident council
Automatic sprinkler system

CMS Star Ratings

Quality Measures
Based on a select set of clinical quality measures.
5/5
Long-Stay Quality
Quality of care delivered to long-term residents.
5/5
Short-Stay Quality
Quality of care delivered to short-term and rehabilitation residents.
5/5
Staffing
Based on nursing staff hours relative to resident needs.
1/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
18
Ratings are assigned by CMS on a one-to-five star scale; five is the highest. Categories without a current CMS rating are not shown.

Staffing & Turnover

Total Nurse Staffing
nurse aide 2.18 · LPN 1.06 · RN 0.64
3.88 hrs per resident per day
Weekend Nurse Staffing
3.39 hrs per resident per day
Physical Therapist Staffing
0.15 hrs per resident per day
Nursing Staff Turnover
Share of nursing staff who left the facility within the past year.
72.1%
Registered Nurse Turnover
71.4%
Administrators Who Have Left
In the past year.
2
Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents
0
Substantiated Complaints
3
Infection-Control Citations
3
Fines
1 totaling $9,386.00
Medicare Payment Denials
0
Total Penalties
1
Counts come from CMS inspections and complaint investigations over approximately the past three years. CMS Care Compare data as of October 1, 2024.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapist
1111 CHURCH AVE
JASPER, IN 47546
Speech-Language Pathologist
1111 CHURCH AVE
JASPER, IN 47546
Physical Therapy Assistant
1111 CHURCH AVE
JASPER, IN 47546
Physical Therapy Assistant
1111 CHURCH AVE
JASPER, IN 47546
Occupational Therapist
1111 CHURCH AVE
JASPER, IN 47546

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brookside Village, Inc's NPI number?

The NPI number for Brookside Village, Inc is 1265419428. It was assigned to this organization in the NPPES registry on December 29, 2005.

Where is Brookside Village, Inc located?

Brookside Village, Inc is located at 1111 Church Ave, Jasper, IN 47546. The listed phone number is (812) 634-7750.

What is Brookside Village, Inc's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Brookside Village, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D0999958) is associated with this NPI, valid through May 28, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Brookside Village, Inc a Medicare-certified nursing home?

Yes. Brookside Village Inc is a Medicare-certified nursing home with 27 certified beds.

What quality rating does Brookside Village, Inc have?

CMS rates Brookside Village Inc 4 out of 5 stars overall on Care Compare. The full measure detail is in the Nursing Home Quality Ratings section above.

What insurance does Brookside Village, Inc accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource list Brookside Village, Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Brookside Village, Inc was last updated on March 20, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.