NPIMap

Organization Active NPI

Brookville Center for Childrens Services Inc

  • Mental Illness Intermediate Care Facility
  • Lido Beach, NY
National Provider Identifier
1003053885
Registry record updated Jan 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
Legal business name
BROOKVILLE CENTER FOR CHILDRENS SERVICES INC
Practice address
28 Seaspray Dr
Lido Beach, NY 11561-5232
Phone
(516) 626-1075
Fax
(516) 626-3308
NPI assigned
Jan 15, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Willard T Derr
Title
Chief Financial Officer
Phone
(516) 626-1075

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X Primary

Addresses

Primary practice location

28 Seaspray Dr
Lido Beach, NY 11561-5232

Mailing address

189 Wheatley Rd
Glen Head, NY 11545-2641
Phone (516) 626-1075

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 33H438

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BROOKVILLE CENTER FOR CHILDREN'S SERVICES
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 1, 2009
Last certification
Feb 13, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
28 Seaspray Drive
Lido Beach, NY 11561

National Provider Directory

National Provider Directory
Tax ID family
Brookville Center for Childrens Services Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231977600000",
    "number": "1003053885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 WHEATLEY RD",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115452641",
            "telephone_number": "516-626-1075",
            "fax_number": "516-626-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 SEASPRAY DR",
            "city": "LIDO BEACH",
            "state": "NY",
            "postal_code": "115615232",
            "telephone_number": "516-626-1075",
            "fax_number": "516-626-3308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKVILLE CENTER FOR CHILDRENS SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-15",
        "last_updated": "2009-01-15",
        "status": "A",
        "authorized_official_last_name": "DERR",
        "authorized_official_first_name": "WILLARD",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "516-626-1075",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lido Beach, NY

Sources for this page

Verify at the official NPI Registry.