Healthcare Provider Details

I. General information

NPI: 1063419331
Provider Name (Legal Business Name): BRANDYWINE CONVALESCENT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 GREENBANK RD
WILMINGTON DE
19808-3164
US

IV. Provider business mailing address

505 GREENBANK RD
WILMINGTON DE
19808-3164
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0101
  • Fax: 302-998-2922
Mailing address:
  • Phone: 302-998-0101
  • Fax: 302-998-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1001
License Number StateDE

VIII. Authorized Official

Name: MR. JAMES M. MULROY JR.
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-630-2400