Provider Demographics
NPI:1164862132
Name:BROOKSIDE OPERATOR LLC
Entity Type:Organization
Organization Name:BROOKSIDE OPERATOR LLC
Other - Org Name:THE BROOKSIDE REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NACHUM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROKEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-232-9217
Mailing Address - Street 1:575 ROUTE 70
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4042
Mailing Address - Country:US
Mailing Address - Phone:732-606-5973
Mailing Address - Fax:732-608-2976
Practice Address - Street 1:1561 COLD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267
Practice Address - Country:US
Practice Address - Phone:413-458-8127
Practice Address - Fax:732-608-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
225189Medicare Oscar/Certification