Provider Demographics
NPI:1154210003
Name:BROOKSHAVEN LLC
Entity type:Organization
Organization Name:BROOKSHAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-822-3835
Mailing Address - Street 1:1503 LASALLE AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-4639
Mailing Address - Country:US
Mailing Address - Phone:757-822-3835
Mailing Address - Fax:888-830-5926
Practice Address - Street 1:1503 LASALLE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4639
Practice Address - Country:US
Practice Address - Phone:757-822-3835
Practice Address - Fax:888-830-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility