Provider Demographics
NPI:1417035866
Name:BRANDYWINE SENIOR CARE OF MOORESTOWN LLC
Entity type:Organization
Organization Name:BRANDYWINE SENIOR CARE OF MOORESTOWN LLC
Other - Org Name:<UNAVAIL>
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 1:2029 MORRIS AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6013
Mailing Address - Country:US
Mailing Address - Phone:908-686-3233
Mailing Address - Fax:908-686-3668
Practice Address - Street 1:1205 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1198
Practice Address - Country:US
Practice Address - Phone:856-778-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106001310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8647208Medicaid
NJ8647208Medicaid