Provider Demographics
NPI:1396818688
Name:BROOKSBY VILLAGE INC
Entity Type:Organization
Organization Name:BROOKSBY VILLAGE INC
Other - Org Name:OUTPATIENT REHABILITATION CLINIC AT BROOKSBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RATHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2390
Mailing Address - Street 1:100 BROOKSBY VILLAGE DR
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1438
Mailing Address - Country:US
Mailing Address - Phone:978-536-2150
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:302 BROOKSBY VILLAGE DRIVE
Practice Address - Street 2:ATTN: REHABILITATION MANAGER
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-8563
Practice Address - Country:US
Practice Address - Phone:978-536-2150
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48CI261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226539Medicare Oscar/Certification