MEDICARE: BRAVERHOOD

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	251C00000X	Developmentally Disabled Services Day Training Agency	02784834

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619166741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAVERHOOD

Provider Business Mailing Address
First Line	:	1527 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5023
Country	:	US
Telephone Number	:	718-336-6073
Fax Number	:	718-336-6071

Provider Business Practice Location Address
First Line	:	1527 60TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5023
Country	:	US
Telephone Number	:	718-336-6073
Fax Number	:	718-336-6071

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ISRAEL BENEDEK
Credential	:
Telephone Number	:	718-336-6073

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	03/03/2022

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Directions to “BRAVERHOOD ” Practice Location

Language	Start Address	Practice Location

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