Provider Demographics
NPI:1134302607
Name:BRANDYWINE ASSISTED LIVING @ SYCAMORE, LLC
Entity Type:Organization
Organization Name:BRANDYWINE ASSISTED LIVING @ SYCAMORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-303-3167
Mailing Address - Street 1:5 MERIDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4353
Mailing Address - Country:US
Mailing Address - Phone:732-202-2600
Mailing Address - Fax:732-202-2690
Practice Address - Street 1:5 MERIDIAN WAY
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4353
Practice Address - Country:US
Practice Address - Phone:732-202-2600
Practice Address - Fax:732-202-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ55A007310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0145513Medicaid