Basic Information
| Provider Information | |||||||||
| NPI: | 1629443353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOKDALE FAMILY CARE CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BROOKDALE PLAZA | ||||||||
| Address2: | SUITE 666 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405811 | ||||||||
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| Practice Location | |||||||||
| Address1: | 465 NEW LOTS AVENUE AT WYONA STREET | ||||||||
| Address2: | BFCC NEW LOTS | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112076414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182408950 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2015 | ||||||||
| LastUpdateDate: | 05/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | SALVO | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7182405811 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 281467 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.