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General NPI Number Information
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NPI Number | 1760601975
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Entity Type | Organization
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Legal Business Name | BROOKFIELD, INC.
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10187 BROOK RD
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City | GLEN ALLEN
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State | VA
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Zip | 23059-6508
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Country | US
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Telephone | 804-266-7631
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Fax | 804-264-6127
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Provider Business Mailing Address
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Address Line | 10187 BROOK RD
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City | GLEN ALLEN
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State | VA
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Zip | 23059-6508
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Country | US
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Telephone | 804-266-7631
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Fax | 804-264-6127
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TIMOTHY M READING
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Credential |
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Telephone | 804-266-7631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 0904006443
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License Number State | VA
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