Provider Demographics
NPI:1225162308
Name:BROTHERS OF CHARITY, INC.
Entity Type:Organization
Organization Name:BROTHERS OF CHARITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LONSWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MAT
Authorized Official - Phone:215-887-6361
Mailing Address - Street 1:7720 DOE LN
Mailing Address - Street 2:
Mailing Address - City:LAVEROCK
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7228
Mailing Address - Country:US
Mailing Address - Phone:215-887-6361
Mailing Address - Fax:215-887-6372
Practice Address - Street 1:7720 DOE LN
Practice Address - Street 2:
Practice Address - City:LAVEROCK
Practice Address - State:PA
Practice Address - Zip Code:19038-7228
Practice Address - Country:US
Practice Address - Phone:215-887-6361
Practice Address - Fax:215-887-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA120560320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities