Provider Demographics
NPI:1598876732
Name:BROOKS - TLC HOSPITAL SYSTEM, INC.
Entity Type:Organization
Organization Name:BROOKS - TLC HOSPITAL SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LAROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-363-7207
Mailing Address - Street 1:529 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2514
Mailing Address - Country:US
Mailing Address - Phone:716-366-1111
Mailing Address - Fax:
Practice Address - Street 1:845 ROUTE 5 AND 20
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9706
Practice Address - Country:US
Practice Address - Phone:716-951-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKS-TLC HOSPITAL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00347544Medicaid
NY00347544Medicaid