Provider Demographics
NPI:1790491876
Name:BROOKFIELD HEALTH SERVICES
Entity Type:Organization
Organization Name:BROOKFIELD HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGENDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-979-0905
Mailing Address - Street 1:604 SOLAREX CT UNIT 205
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8655
Mailing Address - Country:US
Mailing Address - Phone:240-659-8119
Mailing Address - Fax:
Practice Address - Street 1:120 W CHURCH ST STE 2F
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-7812
Practice Address - Country:US
Practice Address - Phone:301-979-0905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)