# BRANDYWINE SENIOR LIVING AT WALL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851678874
- **Authorized official:** MR. KEITH R PHILLIPS (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (856) 813-2017

## Contact information

- **Practice address:** 2021 HIGHWAY 35, WALL TOWNSHIP, NJ 07719-3539
- **Practice address phone:** (856) 813-2000
- **Practice address fax:** (856) 813-2020
- **Mailing address:** 525 FELLOWSHIP RD STE 360, MOUNT LAUREL, NJ 08054-3406
- **Mailing address phone:** (856) 813-2000
- **Mailing address fax:** (856) 813-2020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NJ | Yes |

## Other

- **Enumeration date:** 11/04/2011
- **Last updated:** 11/04/2011