Provider Demographics
NPI:1043334246
Name:CRP/BWN LITCHFIELD OPERATOR, LLC
Entity Type:Organization
Organization Name:CRP/BWN LITCHFIELD OPERATOR, LLC
Other - Org Name:BRANDYWINE ASSISTED LIVING @ LITCHFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGARNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-813-2000
Mailing Address - Street 1:19 CONSTITUTION WAY
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-3428
Mailing Address - Country:US
Mailing Address - Phone:860-567-9500
Mailing Address - Fax:
Practice Address - Street 1:19 CONSTITUTION WAY
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-3428
Practice Address - Country:US
Practice Address - Phone:860-567-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANDYWINE SENIOR LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0118310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility