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NPI Code Detail

MEDICARE: BRYN MAWR CARE, INC.

MEDICARE: BRYN MAWR CARE, INC.
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
1310500000XMental Illness Intermediate Care Facility0035618IL

General Provider Information

NPI Number : 1891790242
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRYN MAWR CARE, INC.
Provider Business Mailing Address
First Line : 4100 W PRATT AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-3517
Country : US
Telephone Number : 847-675-7979
Fax Number : 847-674-5267
Provider Business Practice Location Address
First Line : 5547 N KENMORE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1515
Country : US
Telephone Number : 773-561-7040
Fax Number : 773-561-7543
Authorized Official
Title or Position : CFO
Name : MR. THOMAS WINTER
Credential : CPA
Telephone Number : 847-675-7979
Provider Enumeration Date : 06/14/2005
Last Update Date : 09/04/2015

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