1528349693 NPI number — BRANDYWINE SENIOR LIVING AT PRINCETON, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528349693 NPI number — BRANDYWINE SENIOR LIVING AT PRINCETON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRANDYWINE SENIOR LIVING AT PRINCETON, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528349693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 FELLOWSHIP RD
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-3415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-813-2000
Provider Business Mailing Address Fax Number:
856-813-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 RAYMOND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-9608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-813-2000
Provider Business Practice Location Address Fax Number:
856-813-2020
Provider Enumeration Date:
09/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
856-813-2017

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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