Provider Demographics
NPI:1013377506
Name:BRIGHTVIEW RANDOLPH, LLC
Entity Type:Organization
Organization Name:BRIGHTVIEW RANDOLPH, LLC
Other - Org Name:BRIGHTVIEW RANDOLPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BRIGHTVIEW RANDOLPH, LLC BY DOUG DO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLLENBERG, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-962-0595
Mailing Address - Street 1:218 N. CHARLES STREET
Mailing Address - Street 2:#220
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-962-0595
Mailing Address - Fax:410-347-0587
Practice Address - Street 1:175 QUAKER CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-348-9857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)