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General NPI Number Information
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NPI Number | 1811363757
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Entity Type | Organization
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Legal Business Name | BRANDYWINE SENIOR LIVING AT MAHWAH
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 814 WYCKOFF AVE
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City | MAHWAH
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State | NJ
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Zip | 07430-3132
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Country | US
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Telephone | 201-800-8070
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Fax | 201-800-8041
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Provider Business Mailing Address
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Address Line | 814 WYCKOFF AVE
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City | MAHWAH
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State | NJ
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Zip | 07430-3132
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Country | US
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Telephone | 201-800-8070
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Fax | 201-800-8041
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. KEITH PHILLIPS
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Credential |
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Telephone | 856-813-2000
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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 | 02A024
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License Number State | NJ
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