Provider Demographics
NPI:1811363757
Name:BRANDYWINE SENIOR LIVING AT MAHWAH
Entity Type:Organization
Organization Name:BRANDYWINE SENIOR LIVING AT MAHWAH
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:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-813-2000
Mailing Address - Street 1:814 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3132
Mailing Address - Country:US
Mailing Address - Phone:201-800-8070
Mailing Address - Fax:201-800-8041
Practice Address - Street 1:814 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3132
Practice Address - Country:US
Practice Address - Phone:201-800-8070
Practice Address - Fax:201-800-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ02A024310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility