Provider Demographics
NPI:1225189822
Name:BRANDYWINE ASSISTED LIVING
Entity Type:Organization
Organization Name:BRANDYWINE ASSISTED LIVING
Other - Org Name:BRANDYWINE AT THE GABLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LINTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-686-3233
Mailing Address - Street 1:515 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7744
Mailing Address - Country:US
Mailing Address - Phone:732-836-1400
Mailing Address - Fax:
Practice Address - Street 1:515 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7744
Practice Address - Country:US
Practice Address - Phone:732-836-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ90143310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7796901Medicaid