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General NPI Number Information
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NPI Number | 1215602792
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 15358 W POST CIR
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City | SURPRISE
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State | AZ
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Zip | 85374-1422
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Country | US
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Telephone | 408-393-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 572 W BONO BLVD
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-3113
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Country | US
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Telephone | 408-373-9465
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLE BRADLEY SKELTON
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Credential |
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Telephone | 408-393-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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