Provider Demographics
NPI:1376780262
Name:BROOKVILLE CENTER FOR CHILDRENS SERVICES INC
Entity Type:Organization
Organization Name:BROOKVILLE CENTER FOR CHILDRENS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-626-1075
Mailing Address - Street 1:189 WHEATLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2641
Mailing Address - Country:US
Mailing Address - Phone:516-626-1075
Mailing Address - Fax:516-626-3308
Practice Address - Street 1:26 SEASPRAY DR
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-5232
Practice Address - Country:US
Practice Address - Phone:516-626-1075
Practice Address - Fax:516-626-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness