Active NPI
Northeast SNF Operations
- Skilled Nursing Facility
- Bryn Mawr, PA
National Provider Identifier
1124608187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- NORTHEAST SNF OPERATIONS
- Practice address
- 773 E Haverford
Bryn Mawr, PA 19010 - Phone
- (610) 525-8300
- NPI assigned
- Apr 13, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charles Light
- Title
- Chief Executive
- Phone
- (917) 797-3669
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
773 E Haverford
Bryn Mawr, PA 19010
Mailing address
773 E Haverford
Bryn Mawr, PA 19010
Phone (610) 525-8300
Other names 1
- Bryn Mawr Village
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211122000780 | PA | Part A Provider - Skilled Nursing Facility | 7214326818 | Practice locations: Bryn Mawr, PA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1124608187. Details of each certification follow.
Skilled nursing facility certification: CCN 395095
- Legal name
- NORTHEAST SNF OPERATIONS LLC
- Doing business as
- BRYN MAWR VILLAGE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF (Medicare) only
- Participating since
- Jan 1, 1967
- Last certification
- Mar 6, 2025
- Beds
- 120
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- LLC
- Incorporated
- Mar 10, 2021 in PA
- Enrollment address
- 773 E Haverford Road
Bryn Mawr, PA 19010-3837 - Nursing home name
- BRYN MAWR VILLAGE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Bryn Mawr Village
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare
- Ownership
- Non profit - Corporation
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 120
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D2297381 | Bryn Mawr Village | Certificate of waiver | Jan 15, 2028 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Compassionate Care Healthcare Consultants LLC | Operational/Managerial Control | Aug 30, 2021 | 100% |
| Cory Wake | Corporate Director | Aug 30, 2021 | 100% |
| Akiko Ike | Corporate Director | Aug 30, 2021 | 100% |
| Haverford Holding Company Inc | 5% Or Greater Direct Ownership Interest | Aug 30, 2021 | 100% |
| John Fredericks | W-2 Managing Employee | Aug 30, 2021 | 100% |
| Miriam Braunstein | Corporate Director | Aug 30, 2021 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618272000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1770681600000",
"number": "1124608187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "773 E HAVERFORD",
"city": "BRYN MAWR",
"state": "PA",
"postal_code": "19010",
"telephone_number": "610-525-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "773 E HAVERFORD",
"city": "BRYN MAWR",
"state": "PA",
"postal_code": "19010",
"telephone_number": "610-525-8300"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTHEAST SNF OPERATIONS",
"organizational_subpart": "NO",
"enumeration_date": "2021-04-13",
"last_updated": "2026-02-10",
"certification_date": "2026-02-10",
"status": "A",
"authorized_official_last_name": "LIGHT",
"authorized_official_first_name": "CHARLES",
"authorized_official_title_or_position": "CHIEF EXECUTIVE",
"authorized_official_telephone_number": "917-797-3669"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Bryn Mawr Village",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Bryn Mawr, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.