NPIMap

Organization Active NPI

Brookhaven Rehabilitation and Health Care Center LLC

  • Skilled Nursing Facility
  • Far Rockaway, NY
National Provider Identifier
1477609188
Registry record updated Jun 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BROOKHAVEN REHABILITATION AND HEALTH CARE CENTER LLC
Practice address
250 Beach 17TH St
Far Rockaway, NY 11691-4420
Phone
(718) 471-7500
Fax
(718) 327-9074
NPI assigned
Jan 26, 2007
Last updated
Jun 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2016

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

Authorized official

Name
Mr. Deborah A Flack
Title
Administrator
Phone
(718) 471-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

250 Beach 17TH St
Far Rockaway, NY 11691-4420

Mailing address

250 Beach 17TH St
Far Rockaway, NY 11691-4420
Phone (718) 471-7500

Other identifiers 2

IdentifierTypeStateIssuer
010144884MedicaidVA
02046826MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110928000400 NY Part A Provider - Skilled Nursing Facility 8325225246 Practice locations: Far Rockaway, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477609188. Details of each certification follow.

Skilled nursing facility certification: CCN 335582001

Legal name
BROOKHAVEN REHABILITATION AND HEALTH CARE CENTER LLC
Organization structure
LLCProprietary
Incorporated
May 1, 2000 in NY
Enrollment address
250 Beach 17TH St
Far Rockaway, NY 11691-4420
Nursing home name
BROOKHAVEN REHAB & HEALTH CARE CENTER L L C
Affiliated entity
BENJAMIN LANDA

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mayer Fischel Individual 5% Or Greater Direct Ownership Interest Apr 11, 2011 10%
Teddy Lichtschein Individual 5% Or Greater Direct Ownership Interest Apr 11, 2011 7.5%
Jody Bonura Individual W-2 Managing EmployeeAdministrator Oct 13, 2015
Jack Janklowicz Individual 5% Or Greater Direct Ownership Interest Apr 11, 2011 6.25%
Leonard Janklowicz Individual 5% Or Greater Direct Ownership Interest Apr 11, 2011 6.25%
Benjamin Landa Individual 5% Or Greater Direct Ownership Interest Apr 11, 2011 30.75%
Theodore Pollak Individual 5% Or Greater Direct Ownership Interest Apr 11, 2011 6%

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464825600000",
    "number": "1477609188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 BEACH 17TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116914420",
            "telephone_number": "718-471-7500",
            "fax_number": "718-327-9074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 BEACH 17TH ST",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116914420",
            "telephone_number": "718-471-7500",
            "fax_number": "718-327-9074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN REHABILITATION AND HEALTH CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2016-06-02",
        "status": "A",
        "authorized_official_last_name": "FLACK",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "718-471-7500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010144884",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02046826",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Far Rockaway, NY

Sources for this page

Verify at the official NPI Registry.