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BRANDYWYNE ASSISTED LIVING FACILITY, LLC.
NPI 1477060754
Assisted Living Facility in Winter Haven, FL

Active since January 08, 2018CLIA 10D2209073 · Waiver
1801 LAKE MARIAM DR, WINTER HAVEN, FL 33884(813) 293-9981 Get Directions Write a Review

NPPES record last updated: January 8, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Brandywyne Assisted Living Facility, Llc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRANDYWYNE ASSISTED LIVING FACILITY, LLC. (NPI 1477060754) is a healthcare organization registered as an assisted living facility in Winter Haven, Florida and active in the NPI registry since January 2018. The organization holds a CLIA Waiver certificate valid through January 10, 2027 and lists Khalid Sakr, Manager, as its authorized official.

NPPES Registry Identity

NPI1477060754
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameBRANDYWYNE ASSISTED LIVING FACILITY, LLC.
Location Address1801 LAKE MARIAM DRWinter Haven, FL 33884-0927
Mailing Address1908 E 131st AveTampa, FL 33612-4690 · (813) 293-9981
Phone(813) 293-9981
Organization SubpartNo
Authorized OfficialKhalid SakrManager · (727) 439-5363
Enumeration DateJanuary 8, 2018
✔ NPI 1477060754 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
1801 LAKE MARIAM DR, Winter Haven, FL 33884
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2209073

Brandywyne Assisted Living Facility LLC · Winter Haven, FL
Active · expires Jan 10, 2027
CLIA Number10D2209073
Laboratory TypeAssisted Living Facility
Certificate Effective DateJanuary 11, 2025
Certificate Expiration DateJanuary 10, 2027
Laboratory DirectorBasim Saed
Laboratory Phone(863) 877-0413
Laboratory LocationBrandywyne Assisted Living Facility LLC1801 Lake Mariam Dr, Winter Haven, FL 33884
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAKE MARIAM FL OPCO LLC
Skilled Nursing Facility
1801 LAKE MARIAM DR
WINTER HAVEN, FL 33884
Polk County (863) 293-1989
WINTER HAVEN NURSING LLC
Skilled Nursing Facility
1801 LAKE MARIAM DR
WINTER HAVEN, FL 33884
Polk County (863) 293-1989
BRANDYWINE CONVALESCENT CENTER INC
Skilled Nursing Facility
1801 LAKE MARIAM DR
WINTER HAVEN, FL 33884
Polk County (863) 293-1989

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brandywyne Assisted Living Facility, LLC.'s NPI number?

The NPI number for Brandywyne Assisted Living Facility, LLC. is 1477060754. It was assigned to this organization in the NPPES registry on January 8, 2018.

Where is Brandywyne Assisted Living Facility, LLC. located?

Brandywyne Assisted Living Facility, LLC. is located at 1801 Lake Mariam Dr, Winter Haven, FL 33884. The listed phone number is (813) 293-9981.

What is Brandywyne Assisted Living Facility, LLC.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Brandywyne Assisted Living Facility, LLC. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2209073) is associated with this NPI, valid through January 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Brandywyne Assisted Living Facility, LLC. was last updated on January 8, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.