Basic Information
| Provider Information | |||||||||
| NPI: | 1760666150 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 290 RED SCHOOL LANE ALF OPERATIONS LLC | ||||||||
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| OtherOrganizationName: | BRAKELEY PARK CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E STREET RD | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193481701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109254436 | ||||||||
| FaxNumber: | 6109254351 | ||||||||
| Practice Location | |||||||||
| Address1: | 290 RED SCHOOL LN | ||||||||
| Address2: | |||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088652276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088592800 | ||||||||
| FaxNumber: | 9088594532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2007 | ||||||||
| LastUpdateDate: | 12/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | WILKINSON | ||||||||
| AuthorizedOfficialFirstName: | MARCELLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6109254045 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 953335 | NJ | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.