Provider Demographics
NPI:1659575959
Name:BROOKE GROVE FOUNDATION, INC.
Entity Type:Organization
Organization Name:BROOKE GROVE FOUNDATION, INC.
Other - Org Name:THE WOODS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-924-2811
Mailing Address - Street 1:1614 HICKORY KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1347
Mailing Address - Country:US
Mailing Address - Phone:301-924-2811
Mailing Address - Fax:
Practice Address - Street 1:1614 HICKORY KNOLL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1347
Practice Address - Country:US
Practice Address - Phone:301-924-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15AL139310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility