1013044668 NPI number — BROOKLAND SENIOR DAY CARE CENTER, INC.

Table of content: (NPI 1013044668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013044668 NPI number — BROOKLAND SENIOR DAY CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKLAND SENIOR DAY CARE CENTER, INC.
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:
Provider Other Organization Name Type Code:
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:
1013044668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60183
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20039-0183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-291-2173
Provider Business Mailing Address Fax Number:
202-291-1085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6210 CHILLUM PL NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20011-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-716-5667
Provider Business Practice Location Address Fax Number:
202-722-8518
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRAME
Authorized Official First Name:
JANET
Authorized Official Middle Name:
S
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
301-270-6261

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  261QA0600X , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 026075800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 034788207 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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