Provider Demographics
NPI:1477060754
Name:BRANDYWYNE ASSISTED LIVING FACILITY, LLC.
Entity Type:Organization
Organization Name:BRANDYWYNE ASSISTED LIVING FACILITY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-439-5363
Mailing Address - Street 1:1908 E 131ST AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4690
Mailing Address - Country:US
Mailing Address - Phone:813-293-9981
Mailing Address - Fax:
Practice Address - Street 1:1801 LAKE MARIAM DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-0927
Practice Address - Country:US
Practice Address - Phone:813-293-9981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility