Brandywine Senior Living at Wall

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BRANDYWINE SENIOR LIVING AT WALL

Practice address

2021 Highway 35
Wall Township, NJ 07719-3539

Phone

(856) 813-2000

Fax

(856) 813-2020

NPI assigned

Nov 4, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Keith R Phillips

Title

Chief Financial Officer

Phone

(856) 813-2017

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320364800000",
    "number": "1851678874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 FELLOWSHIP RD STE 360",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080543406",
            "telephone_number": "856-813-2000",
            "fax_number": "856-813-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 HIGHWAY 35",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077193539",
            "telephone_number": "856-813-2000",
            "fax_number": "856-813-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDYWINE SENIOR LIVING AT WALL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-04",
        "last_updated": "2011-11-04",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "856-813-2017",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Bosland, DPT
• Joseph Eli Bouganim, MD
• Angela Bouton, FNP-C
• Brain Health Center
• Brandywine Senior Living at Wall
• Mariah E Bricker
• Heather Brown, OTR/L
• Mary Bruce-Kulcsar, LCSW
• Stephen Richard Bruno, DC
• Patrick S Buckley, MD

• Skilled Nursing Facility in Wall Township, NJ
• Providers in Wall Township, NJ by specialty
• Skilled Nursing Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; 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.