Church Lane Senior Services, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

023102 Issued in PA

Legal business name

CHURCH LANE SENIOR SERVICES, LLC

Doing business as

Brighten at Broomall

Practice address

43 Church LN
Broomall, PA 19008-2503

Phone

(610) 356-3003

Fax

(610) 353-5859

NPI assigned

May 31, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael J. Callan

Title

Chief Financial Officer

Phone

(610) 527-4277

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brighten at Broomall Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194728493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "956 E RAILROAD AVE",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103831",
            "telephone_number": "610-525-8412",
            "fax_number": "610-525-1371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 CHURCH LN",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190082503",
            "telephone_number": "610-356-3003",
            "fax_number": "610-353-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCH LANE SENIOR SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CALLAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "610-527-4277",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "023102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009799700001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brighten at Broomall",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jessica Cirillo
• Jennifer L Claves, MD
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• Skilled Nursing Facility in Broomall, PA
• Providers in Broomall, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.