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General NPI Number Information
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NPI Number | 1578163309
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN CARE CENTER
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 111 BEAVER DAM RD
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City | BROOKHAVEN
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State | NY
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Zip | 11719-9715
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Country | US
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Telephone | 631-286-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 111 BEAVER DAM RD
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City | BROOKHAVEN
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State | NY
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Zip | 11719-9715
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Country | US
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Telephone | 631-286-2500
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Fax |
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Authorized Official
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Title or Position | OPERATOR DESIGNEE
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Name | DANIEL ZEIDMAN
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Credential |
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Telephone | 516-297-8362
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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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