Healthcare Provider Details

I. General information

NPI: 1700756103
Provider Name (Legal Business Name): BRANDYWINE CENTER FOR MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 YORKLYN RD FL 1
HOCKESSIN DE
19707-9688
US

IV. Provider business mailing address

860 1ST AVE STE 2
KING OF PRUSSIA PA
19406-4033
US

V. Phone/Fax

Practice location:
  • Phone: 772-812-9652
  • Fax: 833-535-0164
Mailing address:
  • Phone: 772-812-9652
  • Fax: 833-535-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JARED TURNER
Title or Position: BILLING MANAGER
Credential:
Phone: 772-812-9652