Provider Demographics
NPI:1164416905
Name:BROOKLYN COMMUNITY ESTATE, INC.
Entity Type:Organization
Organization Name:BROOKLYN COMMUNITY ESTATE, INC.
Other - Org Name:BROOKLYN COMMUNITY ESTATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:641-522-9263
Mailing Address - Street 1:406 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:IA
Mailing Address - Zip Code:52211-9444
Mailing Address - Country:US
Mailing Address - Phone:641-522-9263
Mailing Address - Fax:641-522-5684
Practice Address - Street 1:406 NORTH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:IA
Practice Address - Zip Code:52211-9444
Practice Address - Country:US
Practice Address - Phone:641-522-9263
Practice Address - Fax:641-522-5684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA790412313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165594Medicare Oscar/Certification