MEDICARE: BREA WAYNE, 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
1	310400000X	Assisted Living Facility	70A003	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891903175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREA WAYNE, LLC

Provider Business Mailing Address
First Line	:	6737 W WASHINGTON ST
Second Line	:	SUITE 2300
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-5647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 HAMBURG TPKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2019
Country	:	US
Telephone Number	:	973-942-4800
Fax Number	:

Authorized Official
Title or Position	:	EVP, CHIEF ADMIN. OFFICER
Name	:	BRYAN RICHARDSON
Credential	:
Telephone Number	:	615-564-8131

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	05/16/2016

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Directions to “BREA WAYNE, LLC ” Practice Location

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