BROOKDALE DEER CREEK - NPI 1205163995 - Assisted Living Facility in Deerfield Beach, FL

Q: What is the provider's specialty?

The provider's specialty is Assisted Living Facility with taxonomy code 310400000X.

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About Brookdale Deer Creek NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROOKDALE DEER CREEK (NPI 1205163995) is a healthcare organization registered as an assisted living facility in Deerfield Beach, Florida and active in the NPI registry since November 2009. The organization lists Bryan Richardson, Evp, Chief Admin. Officer, as its authorized official.

NPPES Registry Identity

NPI1205163995

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameSUMMERVILLE 17, LLC

Location Address2403 W HILLSBORO BLVDDeerfield Beach, FL 33442-8507

Mailing Address6737 W Washington St, Suite 2300Milwaukee, WI 53214-5647

Phone(954) 426-3800

Organization SubpartNo

Authorized OfficialBryan RichardsonEvp, Chief Admin. Officer · (615) 564-8131

Enumeration DateNovember 17, 2009

Last NPPES UpdateMay 13, 2016

✔ NPI 1205163995 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

License✔ Licensed in FL · AL9401

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

2403 W HILLSBORO BLVD, Deerfield Beach, FL 33442

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Other Names 1

Doing Business AsBrookdale Deer Creek

Other Identifiers 1

Medicaid0122941-00FL

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0965576

Brookdale Deer Creek · Deerfield Beach, FL

Expired · Jun 12, 2026

CLIA Number10D0965576

Laboratory TypeAssisted Living Facility

Certificate Effective DateJune 13, 2024

Certificate Expiration DateJune 12, 2026

Laboratory DirectorJohn J. Culhane

Laboratory Phone(954) 426-3800

Laboratory LocationBrookdale Deer Creek2403 W Hillsboro Blvd, Deerfield Beach, FL 33442

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROD RENNA COTA

Occupational Therapy Assistant