Provider Demographics
NPI:1477609188
Name:BROOKHAVEN REHABILITATION AND HEALTH CARE CENTER LLC
Entity Type:Organization
Organization Name:BROOKHAVEN REHABILITATION AND HEALTH CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-471-7500
Mailing Address - Street 1:250 BEACH 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4420
Mailing Address - Country:US
Mailing Address - Phone:718-471-7500
Mailing Address - Fax:718-327-9074
Practice Address - Street 1:250 BEACH 17TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4420
Practice Address - Country:US
Practice Address - Phone:718-471-7500
Practice Address - Fax:718-327-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02046826Medicaid
VA010144884Medicaid
NY5039420001Medicare NSC
VA010144884Medicaid