1376887612 NPI number — BRIARWOOD OPERATOR, LLC

Table of content: (NPI 1376887612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376887612 NPI number — BRIARWOOD OPERATOR, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIARWOOD OPERATOR, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRIARWOOD REHABILITATION AND HEALTHCARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376887612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1030
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08723-0090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-606-5973
Provider Business Mailing Address Fax Number:
732-608-2976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02492-2914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-449-4040
Provider Business Practice Location Address Fax Number:
781-449-4129
Provider Enumeration Date:
11/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ROKEACH
Authorized Official First Name:
NACHUM
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
732-232-9217

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0784 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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