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General NPI Number Information
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NPI Number | 1386631547
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN HEALTH CARE FACILITY LLC
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 801 GAZZOLA DR
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4900
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Country | US
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Telephone | 631-447-8800
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Fax | 631-447-8830
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Provider Business Mailing Address
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Address Line | 801 GAZZOLA DR
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4900
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Country | US
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Telephone | 631-447-8800
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Fax | 631-447-8830
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Authorized Official
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Title or Position | CFO
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Name | MR. RALPH ROSSO
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Credential |
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Telephone | 631-447-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5123304N
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License Number State | NY
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