Provider Demographics
NPI:1952308942
Name:BEAUMONT RETIREMENT SERVICES, INC
Entity Type:Organization
Organization Name:BEAUMONT RETIREMENT SERVICES, INC
Other - Org Name:BEAUMONT AT BRYN MAWR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:J. DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, MBA, CPA
Authorized Official - Phone:610-526-7000
Mailing Address - Street 1:601 N ITHAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1782
Mailing Address - Country:US
Mailing Address - Phone:610-526-7000
Mailing Address - Fax:610-525-0293
Practice Address - Street 1:601 N ITHAN AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1782
Practice Address - Country:US
Practice Address - Phone:610-526-7000
Practice Address - Fax:610-525-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA026802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395753Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER