Provider Demographics
NPI:1568043768
Name:BROOKSIDE SNF OPERATIONS LLC
Entity Type:Organization
Organization Name:BROOKSIDE SNF OPERATIONS LLC
Other - Org Name:BROOKSIDE REHAB & NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-275-4510
Mailing Address - Street 1:1007 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1246
Mailing Address - Country:US
Mailing Address - Phone:516-855-5504
Mailing Address - Fax:
Practice Address - Street 1:614 HASTINGS LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2110
Practice Address - Country:US
Practice Address - Phone:540-347-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility