Provider Demographics
NPI:1578522157
Name:BROOME HEALTH CARE SERVICE LLC
Entity Type:Organization
Organization Name:BROOME HEALTH CARE SERVICE LLC
Other - Org Name:BRIDGEWATER CENTER FOR NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EFRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-426-5600
Mailing Address - Street 1:159 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-3103
Mailing Address - Country:US
Mailing Address - Phone:607-722-7225
Mailing Address - Fax:607-724-8765
Practice Address - Street 1:159 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-3103
Practice Address - Country:US
Practice Address - Phone:607-722-7225
Practice Address - Fax:607-724-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0301306N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00309664Medicaid
NY335228Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER