Provider Demographics
NPI:1003325325
Name:BRIGHTVIEW ANNAPOLIS, LLC
Entity Type:Organization
Organization Name:BRIGHTVIEW ANNAPOLIS, LLC
Other - Org Name:BRIGHTVIEW ANNAPOLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BRIGHTVIEW ANNAPOLIS, LLC AUTHORIZE
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-962-0595
Mailing Address - Street 1:1935 GENERALS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:443-808-1232
Mailing Address - Fax:443-499-8270
Practice Address - Street 1:1935 GENERALS HIGHWAY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:443-808-1232
Practice Address - Fax:443-499-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)