Healthcare Provider Details

I. General information

NPI: 1881195782
Provider Name (Legal Business Name): BROOKLINE OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 N BROOKLINE AVE
OKLAHOMA CITY OK
73112-3516
US

IV. Provider business mailing address

PO BOX 990
EDMOND OK
73083-0990
US

V. Phone/Fax

Practice location:
  • Phone: 405-251-2847
  • Fax:
Mailing address:
  • Phone: 405-285-8166
  • Fax: 405-563-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH5513
License Number StateOK

VIII. Authorized Official

Name: SCOTT PILGRIM
Title or Position: MEMBER
Credential:
Phone: 405-285-8166