Provider Demographics
NPI:1265571913
Name:BRANDYWINE SENIOR LIVING AT BRANDALL ESTATES
Entity type:Organization
Organization Name:BRANDYWINE SENIOR LIVING AT BRANDALL ESTATES
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 1:432 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1372
Mailing Address - Country:US
Mailing Address - Phone:609-926-4663
Mailing Address - Fax:609-926-5354
Practice Address - Street 1:432 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1372
Practice Address - Country:US
Practice Address - Phone:609-926-4663
Practice Address - Fax:609-926-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ001A000310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ758002Medicaid