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General NPI Number Information
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NPI Number | 1023064300
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN HOSPITAL, LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 201 S GARNETT RD
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City | TULSA
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State | OK
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Zip | 74128
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Country | US
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Telephone | 918-438-4257
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Fax | 918-438-0083
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Provider Business Mailing Address
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Address Line | 201 S GARNETT RD
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City | TULSA
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State | OK
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Zip | 74128-1805
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Country | US
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Telephone | 918-438-4257
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Fax | 918-438-0083
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Authorized Official
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Title or Position | CFO
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Name | KENNETH NOEL PIERCE
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Credential |
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Telephone | 918-438-4257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 2313
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 2313
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License Number State | OK
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