Provider Demographics
NPI:1629446604
Name:GREAT BROOK ACADEMY LLC
Entity Type:Organization
Organization Name:GREAT BROOK ACADEMY LLC
Other - Org Name:GREAT BROOK EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-268-0600
Mailing Address - Street 1:15 GLASS ST
Mailing Address - Street 2:LL1
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-1509
Mailing Address - Country:US
Mailing Address - Phone:603-268-0600
Mailing Address - Fax:
Practice Address - Street 1:15 GLASS ST
Practice Address - Street 2:LL1
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275-1509
Practice Address - Country:US
Practice Address - Phone:603-268-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport