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General NPI Number Information
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NPI Number | 1942018833
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN MS OPERATING LLC
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 524 BROOKMAN DR
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City | BROOKHAVEN
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State | MS
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Zip | 39601-2384
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Country | US
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Telephone | 601-835-1884
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Fax |
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Provider Business Mailing Address
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Address Line | 710 OBRECHT RD
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City | SYKESVILLE
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State | MD
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Zip | 21784-7650
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED SIGNATORY
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Name | MOISHE MAYER
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Credential |
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Telephone | 718-614-8341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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