Provider Demographics
NPI:1811038524
Name:BRANDYWINE ASSISTED LIVING AT GOVERNOR'S CROSSING
Entity Type:Organization
Organization Name:BRANDYWINE ASSISTED LIVING AT GOVERNOR'S CROSSING
Other - Org Name:
Other - Org Type:
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 1:49 LASATTA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1656
Mailing Address - Country:US
Mailing Address - Phone:732-786-1000
Mailing Address - Fax:732-786-0689
Practice Address - Street 1:49 LASATTA AVE
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1656
Practice Address - Country:US
Practice Address - Phone:732-786-1000
Practice Address - Fax:732-786-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ55A002310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0120561Medicaid