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NPI Code Detail

MEDICARE: VILLAS AT BRYN MAWR LLC

MEDICARE: VILLAS 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 : 1992414429
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLAS AT BRYN MAWR LLC
Provider Business Mailing Address
First Line : 2361 NOSTRAND AVE STE 903
Second Line :
City : BROOKLYN
State : NY
Zip : 11210-3953
Country : US
Telephone Number :
Fax Number :
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 :
Authorized Official
Title or Position : PRESIDENT
Name : MR. JOSH LEGUM
Credential :
Telephone Number : 507-203-1001
Provider Enumeration Date : 11/23/2022
Last Update Date : 11/23/2022

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