Provider Demographics
NPI:1578163309
Name:BROOKHAVEN CARE CENTER
Entity Type:Organization
Organization Name:BROOKHAVEN CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR DESIGNEE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-297-8362
Mailing Address - Street 1:111 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9715
Mailing Address - Country:US
Mailing Address - Phone:631-286-2500
Mailing Address - Fax:
Practice Address - Street 1:111 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719-9715
Practice Address - Country:US
Practice Address - Phone:631-286-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05934510Medicaid