Provider Demographics
NPI:1225654494
Name:BROOKS - TLC HOSPITAL SYSTEM, INC.
Entity Type:Organization
Organization Name:BROOKS - TLC HOSPITAL SYSTEM, INC.
Other - Org Name:SUD CLINICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LAROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-363-7207
Mailing Address - Street 1:529 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2514
Mailing Address - Country:US
Mailing Address - Phone:716-366-1111
Mailing Address - Fax:
Practice Address - Street 1:7020 ERIE ROAD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047
Practice Address - Country:US
Practice Address - Phone:716-947-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit