Active NPI
Brandywine Convalescent Home, Inc.
- Skilled Nursing Facility
- Wilmington, DE
National Provider Identifier
1063419331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1001
- Legal business name
- BRANDYWINE CONVALESCENT HOME, INC.
- Practice address
- 505 Greenbank Rd
Wilmington, DE 19808-3164 - Phone
- (302) 998-0101
- Fax
- (302) 998-2922
- NPI assigned
- Jul 1, 2005
- Organization subpart
- Yes
- Parent organization
- ACCORD HEALTH SERVICE, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. James M. Mulroy Jr.
- Title
- Vice President
- Phone
- (610) 630-2400
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1001 | DE | Primary |
Addresses
Primary practice location
505 Greenbank Rd
Wilmington, DE 19808-3164
Mailing address
505 Greenbank Rd
Wilmington, DE 19808-3164
Phone (302) 998-0101
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000041211 | Medicaid | DE | |
| 0000136112 | Medicaid | DE | |
| 0000439555 | Medicaid | DE | |
| 154054 | Other | DE | BLUE CROSS |
National Provider Directory
National Provider Directory- Part of
- Briarleaf NSG Conv Ctr
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120176000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1452124800000",
"number": "1063419331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 GREENBANK RD",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198083164",
"telephone_number": "302-998-0101",
"fax_number": "302-998-2922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 GREENBANK RD",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198083164",
"telephone_number": "302-998-0101",
"fax_number": "302-998-2922"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRANDYWINE CONVALESCENT HOME, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ACCORD HEALTH SERVICE, INC.",
"enumeration_date": "2005-07-01",
"last_updated": "2016-01-07",
"status": "A",
"authorized_official_last_name": "MULROY",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "M.",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "610-630-2400",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "DE",
"license": "1001",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000041211",
"state": "DE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000136112",
"state": "DE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000439555",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "154054",
"state": "DE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.