Healthcare Provider Details

I. General information

NPI: 1982943445
Provider Name (Legal Business Name): BROOKHAVEN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S GARNETT RD
TULSA OK
74128-1805
US

IV. Provider business mailing address

8014 S WHEELING AVE APT H
TULSA OK
74136-5224
US

V. Phone/Fax

Practice location:
  • Phone: 918-438-4257
  • Fax:
Mailing address:
  • Phone: 580-224-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. ROLF B GAINER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PH.D
Phone: 918-438-4257