Provider Demographics
NPI:1215917224
Name:BROOKS - TLC HOSPITAL SYSTEM, INC.
Entity type:Organization
Organization Name:BROOKS - TLC HOSPITAL SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-363-7260
Mailing Address - Street 1:529 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2514
Mailing Address - Country:US
Mailing Address - Phone:716-375-6490
Mailing Address - Fax:716-363-7228
Practice Address - Street 1:529 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2514
Practice Address - Country:US
Practice Address - Phone:716-375-6490
Practice Address - Fax:716-363-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0601000H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040401000245OtherFIDELIS
NY0001400701OtherUNIVERA
NY6000760OtherBLUE CROSS WNY
NYH33OtherINDEPENDENT HEALTH
NY5Q1Medicaid
NY6000760OtherBLUE CROSS WNY