Healthcare Provider Details

I. General information

NPI: 1639176977
Provider Name (Legal Business Name): BRIARLEAF NURSING AND CONVALESCENT, 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

252 BELMONT AVE
DOYLESTOWN PA
18901-4459
US

IV. Provider business mailing address

252 BELMONT AVE
DOYLESTOWN PA
18901-4459
US

V. Phone/Fax

Practice location:
  • Phone: 215-348-2983
  • Fax: 215-340-1308
Mailing address:
  • Phone: 215-348-2983
  • Fax: 215-340-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number331402
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier27830
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUS HEALTHCARE
# 2
Identifier0007908660002
Identifier TypeMEDICAID
Identifier StatePW
Identifier Issuer
# 3
Identifier005931
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE HMO
# 4
Identifier5931
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerIBC
# 5
Identifier1073452
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE MERCY

VIII. Authorized Official

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