Provider Demographics
NPI:1063419331
Name:BRANDYWINE CONVALESCENT HOME, INC.
Entity type:Organization
Organization Name:BRANDYWINE CONVALESCENT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULROY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:610-630-2400
Mailing Address - Street 1:505 GREENBANK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3164
Mailing Address - Country:US
Mailing Address - Phone:302-998-0101
Mailing Address - Fax:302-998-2922
Practice Address - Street 1:505 GREENBANK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3164
Practice Address - Country:US
Practice Address - Phone:302-998-0101
Practice Address - Fax:302-998-2922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCORD HEALTH SERVICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-01
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000041211Medicaid
DE0000136112Medicaid
DE0000439555Medicaid
DE154054OtherBLUE CROSS
DE0000136112Medicaid