Healthcare Provider Details

I. General information

NPI: 1376887612
Provider Name (Legal Business Name): BRIARWOOD OPERATOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LINCOLN ST
NEEDHAM MA
02492-2914
US

IV. Provider business mailing address

PO BOX 1030
BRICK NJ
08723-0090
US

V. Phone/Fax

Practice location:
  • Phone: 781-449-4040
  • Fax: 781-449-4129
Mailing address:
  • Phone: 732-606-5973
  • Fax: 732-608-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0784
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MR. NACHUM ROKEACH
Title or Position: VP OPERATIONS
Credential:
Phone: 732-232-9217