Provider Demographics
NPI:1982943445
Name:BROOKHAVEN HOSPITAL
Entity Type:Organization
Organization Name:BROOKHAVEN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLF
Authorized Official - Middle Name:B
Authorized Official - Last Name:GAINER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-438-4257
Mailing Address - Street 1:8014 S WHEELING AVE
Mailing Address - Street 2:APT H
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5224
Mailing Address - Country:US
Mailing Address - Phone:580-224-1785
Mailing Address - Fax:
Practice Address - Street 1:201 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-1805
Practice Address - Country:US
Practice Address - Phone:918-438-4257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness