Provider Demographics
NPI:1689447260
Name:BROOKHAVEN HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:BROOKHAVEN HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEAREST
Authorized Official - Middle Name:A
Authorized Official - Last Name:BADIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-498-8850
Mailing Address - Street 1:5615 BROOKLYN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3086
Mailing Address - Country:US
Mailing Address - Phone:763-316-4128
Mailing Address - Fax:763-312-2299
Practice Address - Street 1:3124 65TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2243
Practice Address - Country:US
Practice Address - Phone:215-630-5797
Practice Address - Fax:763-312-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility