Provider Demographics
NPI:1780110304
Name:BROOKS ALTERNATIVE AGENCY INCORPORATED
Entity type:Organization
Organization Name:BROOKS ALTERNATIVE AGENCY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONJI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:800-282-2208
Mailing Address - Street 1:1242 POINT BREEZE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4362
Mailing Address - Country:US
Mailing Address - Phone:800-282-2208
Mailing Address - Fax:856-282-3381
Practice Address - Street 1:175 WHITE HORSE RD W
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3673
Practice Address - Country:US
Practice Address - Phone:800-282-2208
Practice Address - Fax:856-282-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103837225-0001Medicaid
NJ0573965Medicaid