Healthcare Provider Details

I. General information

NPI: 1679106512
Provider Name (Legal Business Name): BROOKLYN POINTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 IDLEWOOD DR
BROOKLYN OH
44144-3131
US

IV. Provider business mailing address

4800 IDLEWOOD DR
CLEVELAND OH
44144-3131
US

V. Phone/Fax

Practice location:
  • Phone: 216-273-1973
  • Fax: 216-661-6259
Mailing address:
  • Phone: 216-273-1973
  • Fax: 216-661-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY J VAUGHN
Title or Position: REIMBURSEMENT ANALYST
Credential:
Phone: 240-595-6025