CCRC - BRANDYWINE, LLC (NPI# 1255342580) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255342580 |
| Entity Type | Organization |
| Organization Name | CCRC - BRANDYWINE, LLC |
| Other Organization Name | FREEDOM VILLAGE AT BRANDYWINE |
| Practice Address |
35 Freedom Blvd Coatesville PA 19320-1549 |
| Practice Telephone | 6103835100 |
| Practice Fax Number | 6103835941 |
| Mailing Telephone | 6103835100 |
| Mailing Fax Number | 6103835941 |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-03-16 |
| Authorized Official Name | MATTHEW HARRISON (VICE PRESIDENT & ASSISTANT SECRETAR) |
| Authorized Official Telephone | 9494070320 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Freedom Village at Brandywine | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 15 Freedom Blvd, Coatesville, PA 193201549 | 6103835100 | 6103835941 |
| Street Address |
35 FREEDOM BLVD |
| City | COATESVILLE |
| State | PA |
| Zip Code | 19320-1549 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962029306 | Ara Dadivanyan | Psychiatry & Neurology | 201 Reeceville Rd., Brandywine Hospital, Coatesville, PA 19320 | 2020-07-01 |
| 1669098919 | Sara Mostafa | Psychiatry & Neurology | Brandy Wine Hospital, 201 Reeceville Rd, Coatesville, PA 19320 | 2020-06-23 |
| 1225654072 | Laurie Bond | Counselor | 774 East Lincoln Highway, Coatesville, PA 19320 | 2020-06-17 |
| 1356964506 | Timothy Robert Derosa | Psychiatry & Neurology | Brandywine Hospital 201 Reeceville Rd., Coatesville, Pa, PA 19320 | 2020-05-22 |
| 1184264632 | Evolve Individual Services, LLC | Counselor | 135 E Chestnut St, 204, Coatesville, PA 19320 | 2020-01-13 |
| 1649824111 | Angela Lynne Sylvina | Social Worker | 1825 E Lincoln Highway, Coatesville, PA 19320 | 2019-08-01 |
| 1629540257 | Rhonda Jean Sanford | Social Worker | Coatesville Vamc, Attn: Rhonda Sanford, Lcsw, 1400 Blackhorse Hill Rd, Bldg 57, Rm 227, Coatesvillle, PA 19320 | 2018-12-20 |
| 1528540499 | Jetquatta Parker | Licensed Practical Nurse | 786 Coates St, Coatesville, PA 19320 | 2018-09-06 |
| 1639608052 | Shafkat Hussain | Pharmacist | 800 East Lincoln Highway, Coatesville, PA 19320 | 2017-06-08 |
| 1790222032 | Elizabeth Barnett | Counselor | 2034crest Dr, Coatesville, PA 19320 | 2017-01-25 |
| Find all providers in zip 19320 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548702483 | Jodi Szklanka | Skilled Nursing Facility | 101 N Radford Way, Coatesville, PA 19320-4347 | 2016-11-09 |
| 1407271851 | Genesis | Skilled Nursing Facility | 916 Greenwood Cir, Coatesville, PA 19320-2133 | 2014-02-21 |
| 1063470151 | Freedom Village Brandywine | Skilled Nursing Facility | 15 Freedom Blvd, Coatesville, PA 19320-1549 | 2006-05-01 |
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| 1689273500 | Southwestern Healthcare Operations LLC | Skilled Nursing Facility | 500 Lewis Run Road, Pittsburgh, PA 15122-3056 | 2020-10-21 |
| 1922626290 | Brsi, Lp | Skilled Nursing Facility | 303 Walnut St Fl 7, Harrisburg, PA 17101-1825 | 2020-07-13 |
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| 1508484502 | Timber Ridge Snf Operations LLC | Skilled Nursing Facility | 1555 East End Boulevard, Plains Twp, PA 18702-7927 | 2020-07-07 |
| 1205456704 | Embassy Sharon, LLC | Skilled Nursing Facility | 959 E. State Street, Sharon, PA 16146 | 2020-04-24 |
| 1952940785 | Newport Meadows Health and Rehabilitation Center LLC | Skilled Nursing Facility | 41 Newport Avenue, Christina, PA 17509-1305 | 2019-12-26 |
| 1851954176 | Silvercare Skilled Nursing LLC | Skilled Nursing Facility | 2600 W 9th St Unit A, Chester, PA 19013-2040 | 2019-04-22 |
| Find all providers with the same taxonomy | ||||
| City | COATESVILLE |
| Zip Code | 19320 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.