Provider Demographics
NPI:1285758771
Name:BROOKDALE FAMILY CARE CENTER, INC.
Entity type:Organization
Organization Name:BROOKDALE FAMILY CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-240-6374
Mailing Address - Street 1:1 BROOKDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3198
Mailing Address - Country:US
Mailing Address - Phone:718-240-6374
Mailing Address - Fax:
Practice Address - Street 1:465 NEW LOTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-6414
Practice Address - Country:US
Practice Address - Phone:718-240-8950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE FAMILY CARE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW32561Medicaid