Healthcare Provider Details

I. General information

NPI: 1023064300
Provider Name (Legal Business Name): BROOKHAVEN HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S GARNETT RD
TULSA OK
74128
US

IV. Provider business mailing address

201 S GARNETT RD
TULSA OK
74128-1805
US

V. Phone/Fax

Practice location:
  • Phone: 918-438-4257
  • Fax: 918-438-0083
Mailing address:
  • Phone: 918-438-4257
  • Fax: 918-438-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number2313
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number2313
License Number StateOK

VIII. Authorized Official

Name: KENNETH NOEL PIERCE
Title or Position: CFO
Credential:
Phone: 918-438-4257