Provider Demographics
NPI:1578505186
Name:BREYUT CONVALESCENT CENTER, LLC
Entity Type:Organization
Organization Name:BREYUT CONVALESCENT CENTER, LLC
Other - Org Name:MERCERVILLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DROPESKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4231
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-925-4436
Mailing Address - Fax:610-925-4351
Practice Address - Street 1:2240 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-2640
Practice Address - Country:US
Practice Address - Phone:609-586-7500
Practice Address - Fax:609-586-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061106314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005636000OtherIBC
2176737OtherAETNA-HMO
NJ4482701OtherUNISYS #
000841OtherHORIZION - SUB
NJ11040Medicaid
315094OtherHORIZION - SNF
0005636000OtherAMERIHEALTH
316925OtherUS FAMILY HEALTH PLAN
NJ11040Medicaid
0005636000OtherIBC
=========OtherCIGNA_NJ
=========OtherLOCAL 825
000841OtherHORIZION - SUB
=========OtherHCPC
=========OtherAETNA-NONHMO
=========OtherUNITED HEALTHCARE