=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255474250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRANDYWINE ASSISTED LIVING AT MIDDLEBROOK CROSSING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2005 ROUTE 22 WEST
-----------------------------------------------------
City | BRIDGEWATER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-868-8181
-----------------------------------------------------
Fax | 732-868-8178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2005 ROUTE 22 WEST PO BOX 6100
-----------------------------------------------------
City | BRIDGEWATER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-868-8181
-----------------------------------------------------
Fax | 732-868-8178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTRACT MANAGER
-----------------------------------------------------
Name | MELISSA B LINTEAU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-686-3233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 80A004
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------