Provider Demographics
NPI:1235410390
Name:BRANDYWINE SENIOR LIVING AT HADDONFIELD, LLC
Entity Type:Organization
Organization Name:BRANDYWINE SENIOR LIVING AT HADDONFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-813-2017
Mailing Address - Street 1:525 FELLOWSHIP RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3415
Mailing Address - Country:US
Mailing Address - Phone:856-813-2000
Mailing Address - Fax:856-813-2020
Practice Address - Street 1:132 WARWICK RD
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-3707
Practice Address - Country:US
Practice Address - Phone:856-813-2000
Practice Address - Fax:856-813-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility