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General NPI Number Information
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NPI Number | 1154210003
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Entity Type | Organization
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Legal Business Name | BROOKSHAVEN LLC
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 1503 LASALLE AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23704-4639
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Country | US
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Telephone | 757-822-3835
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Fax | 888-830-5926
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Provider Business Mailing Address
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Address Line | 1503 LASALLE AVE UNIT C
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City | PORTSMOUTH
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State | VA
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Zip | 23704-4639
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Country | US
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Telephone | 757-822-3835
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Fax | 888-830-5926
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MRS. KRISTAL B BROOKS
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Credential | LCSW
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Telephone | 757-822-3835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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