Provider Demographics
NPI:1538338702
Name:THE BROOKDALE HOSPITAL MEDICAL CENTER
Entity type:Organization
Organization Name:THE BROOKDALE HOSPITAL MEDICAL CENTER
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 1:10101 AVENUE D
Mailing Address - Street 2:IMC ALTERNATIVE HOUSING PROGRAM
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1902
Mailing Address - Country:US
Mailing Address - Phone:718-240-8534
Mailing Address - Fax:718-240-6492
Practice Address - Street 1:1366 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-4535
Practice Address - Country:US
Practice Address - Phone:718-613-6701
Practice Address - Fax:718-613-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02361526Medicaid