Provider Demographics
NPI:1952927352
Name:BROOKVIEW OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:BROOKVIEW OPERATING COMPANY LLC
Other - Org Name:BROOKVIEW HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:R.
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HAZELBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-499-3311
Mailing Address - Street 1:1661 OLD HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3644
Mailing Address - Country:US
Mailing Address - Phone:614-459-0445
Mailing Address - Fax:
Practice Address - Street 1:214 HARDING ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-1314
Practice Address - Country:US
Practice Address - Phone:419-784-1014
Practice Address - Fax:419-784-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1385NOtherLICENSURE