Provider Demographics
NPI:1851396972
Name:BROOKSIDE HEALTHCARE & REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:BROOKSIDE HEALTHCARE & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-262-2255
Mailing Address - Street 1:2630 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3013
Mailing Address - Country:US
Mailing Address - Phone:215-884-6776
Mailing Address - Fax:215-884-4099
Practice Address - Street 1:2630 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:PA
Practice Address - Zip Code:19001-3013
Practice Address - Country:US
Practice Address - Phone:215-884-6776
Practice Address - Fax:215-884-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA181502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019531330001Medicaid
PA395227Medicare Oscar/Certification