MEDICARE: BROOKFIELD HEALTH CARE CENTER, L.L.C.

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	:	1578372173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKFIELD HEALTH CARE CENTER, L.L.C.

Provider Business Mailing Address
First Line	:	1869 CRAIG PARK CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4122
Country	:	US
Telephone Number	:	314-543-3816
Fax Number	:	314-226-1736

Provider Business Practice Location Address
First Line	:	215 E PRATT ST
Second Line	:
City	:	BROOKFIELD
State	:	MO
Zip	:	64628-1300
Country	:	US
Telephone Number	:	660-675-0600
Fax Number	:	660-292-3840

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD J. DESTEFANE
Credential	:
Telephone Number	:	314-422-7910

Provider Enumeration Date	:	01/07/2025
Last Update Date	:	01/07/2025

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