MEDICARE: BRINKLEY HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1093462590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRINKLEY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	362 E KENNEDY BLVD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 N MAIN ST
Second Line	:
City	:	BRINKLEY
State	:	AR
Zip	:	72021-2122
Country	:	US
Telephone Number	:	870-734-3636
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED REP
Name	:	JACOB TAUB
Credential	:
Telephone Number	:	718-838-1500

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/04/2022

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Directions to “BRINKLEY HEALTHCARE LLC ” Practice Location

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