Provider Demographics
NPI:1700028875
Name:BROOKDALE SENIOR LIVING COMMUNITIES INC
Entity Type:Organization
Organization Name:BROOKDALE SENIOR LIVING COMMUNITIES INC
Other - Org Name:BROOKDALE PIQUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LESKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:1744 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-8332
Mailing Address - Country:US
Mailing Address - Phone:937-773-0500
Mailing Address - Fax:937-773-8521
Practice Address - Street 1:1744 W HIGH ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-8332
Practice Address - Country:US
Practice Address - Phone:937-773-0500
Practice Address - Fax:937-773-8521
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-03
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2935784Medicaid