Basic Information
| Provider Information | |||||||||
| NPI: | 1376887612 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIARWOOD OPERATOR, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BRIARWOOD REHABILITATION AND HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1030 | ||||||||
| Address2: | |||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087230090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326065973 | ||||||||
| FaxNumber: | 7326082976 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | NEEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024922914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814494040 | ||||||||
| FaxNumber: | 7814494129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2012 | ||||||||
| LastUpdateDate: | 02/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | ROKEACH | ||||||||
| AuthorizedOfficialFirstName: | NACHUM | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7322329217 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0784 | 05 | MA | MEDICAID |