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NPI Code Detail

MEDICARE: VILLA AT BRYN MAWR LLC

MEDICARE: VILLA AT BRYN MAWR LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1023441524
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLA AT BRYN MAWR LLC
Provider Business Mailing Address
First Line : 275 PENN AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1216
Country : US
Telephone Number : 612-377-4723
Fax Number : 612-377-0294
Provider Business Practice Location Address
First Line : 275 PENN AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55405-1216
Country : US
Telephone Number : 612-377-4723
Fax Number : 612-377-0294
Authorized Official
Title or Position : ATTORNEY
Name : MS. FRANCES MEEHAN
Credential : ESQ.
Telephone Number : 312-521-2467
Provider Enumeration Date : 08/20/2013
Last Update Date : 08/20/2013

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Directions to “VILLA AT BRYN MAWR LLC ” Practice Location

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