Provider Demographics
NPI:1255342580
Name:CCRC - BRANDYWINE, LLC
Entity type:Organization
Organization Name:CCRC - BRANDYWINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:ADWA
Authorized Official - Last Name:MALAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-383-5100
Mailing Address - Street 1:35 FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1549
Mailing Address - Country:US
Mailing Address - Phone:610-383-5100
Mailing Address - Fax:610-383-5941
Practice Address - Street 1:15 FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1549
Practice Address - Country:US
Practice Address - Phone:610-383-5100
Practice Address - Fax:610-383-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396062Medicare Oscar/Certification