Provider Demographics
NPI:1619091857
Name:BRENTWOOD HEALTH CARE
Entity Type:Organization
Organization Name:BRENTWOOD HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:732-219-7080
Mailing Address - Street 1:565 STATE ROUTE 35
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5047
Mailing Address - Country:US
Mailing Address - Phone:732-219-7080
Mailing Address - Fax:732-219-7063
Practice Address - Street 1:565 STATE ROUTE 35
Practice Address - Street 2:SUITE 3B
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5047
Practice Address - Country:US
Practice Address - Phone:732-219-7080
Practice Address - Fax:732-219-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0100200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6087701Medicaid