Provider Demographics
NPI:1770760027
Name:EASTBROOKE GARDENS, INC.
Entity type:Organization
Organization Name:EASTBROOKE GARDENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KLINOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-699-5002
Mailing Address - Street 1:201 N. SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707
Mailing Address - Country:US
Mailing Address - Phone:407-699-5002
Mailing Address - Fax:407-699-4826
Practice Address - Street 1:201 N. SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707
Practice Address - Country:US
Practice Address - Phone:407-699-5002
Practice Address - Fax:407-699-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5355310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility