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General NPI Number Information
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NPI Number | 1518001817
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Entity Type | Organization
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Legal Business Name | BREA WEST ORANGE, LLC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 520 PROSPECT AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-3229
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Country | US
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Telephone | 973-325-5700
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Fax | 973-325-6800
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Provider Business Mailing Address
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Address Line | 6737 W WASHINGTON ST STE 2300
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City | MILWAUKEE
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State | WI
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Zip | 53214-5650
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Country | US
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Telephone | 414-918-5000
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Fax | 206-301-4500
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Authorized Official
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Title or Position | EVP, CHIEF ADMIN. OFFICER
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Name | BRYAN RICHARDSON
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Credential |
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Telephone | 615-564-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 30A001
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License Number State | NJ
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