Provider Demographics
NPI:1891790242
Name:BRYN MAWR CARE, INC.
Entity Type:Organization
Organization Name:BRYN MAWR CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:847-675-7979
Mailing Address - Street 1:4100 W PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3517
Mailing Address - Country:US
Mailing Address - Phone:847-675-7979
Mailing Address - Fax:847-674-5267
Practice Address - Street 1:5547 N KENMORE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1515
Practice Address - Country:US
Practice Address - Phone:773-561-7040
Practice Address - Fax:773-561-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0035618310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness