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NPI Code Detail

MEDICARE: VILLA AT BRYN MAWR LLC

MEDICARE: VILLA AT BRYN MAWR LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1780028878
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLA AT BRYN MAWR LLC
Provider Business Mailing Address
First Line : 3701 W LUNT AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-2615
Country : US
Telephone Number : 847-440-2660
Fax Number :
Provider Business Practice Location Address
First Line : 275 PENN AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1216
Country : US
Telephone Number : 612-377-4723
Fax Number : 612-377-0294
Authorized Official
Title or Position : DIRECTOR
Name : BENJAMIN ISRAEL
Credential :
Telephone Number : 847-440-2655
Provider Enumeration Date : 04/19/2013
Last Update Date : 03/18/2021

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Directions to “VILLA AT BRYN MAWR LLC ” Practice Location

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