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DSH330233B BROOKDALE HOSPITAL MEDICAL CENTER (Active)
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Main Details
Name
BROOKDALE HOSPITAL MEDICAL CENTER
Subdivision Name
Brookdale Family Care Center - Pennsylvania Ave Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330233B
Medicare Provider Number
330233
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/8/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/12/2014
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Brookdale Hospital Medical Center
Diana Sullivan, VP
(718) 240-7449
Primary Contact
Brookdale Hospital
Johnny Ha, Director of Pharmacy
(718) 240-5994
Addresses
Street Address
1110 Pennsylvania Avenue
Brooklyn, NY 11212
Billing Address
Brookdale Hospital Medical Center
ONE BROOKDALE PLAZA
BROOKLYN, NY 11212
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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