Provider Demographics
NPI:1982620522
Name:BRENTWOOD SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BRENTWOOD SURGERY CENTER, LLC
Other - Org Name:BRENTWOOD SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:ROSAMOND
Authorized Official - Last Name:LUCKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:925-240-2059
Mailing Address - Street 1:2400 BALFOUR RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4945
Mailing Address - Country:US
Mailing Address - Phone:925-240-2059
Mailing Address - Fax:925-240-2156
Practice Address - Street 1:2400 BALFOUR RD
Practice Address - Street 2:SUITE 320
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4945
Practice Address - Country:US
Practice Address - Phone:925-240-2059
Practice Address - Fax:925-240-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical