Provider Demographics
NPI:1215602792
Name:BROOKHAVEN ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:BROOKHAVEN ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-393-2002
Mailing Address - Street 1:572 W BONO BLVD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3113
Mailing Address - Country:US
Mailing Address - Phone:408-373-9465
Mailing Address - Fax:
Practice Address - Street 1:15358 W POST CIR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-1422
Practice Address - Country:US
Practice Address - Phone:408-393-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility