Provider Demographics
NPI:1033757786
Name:BH BRIGHTVIEW SOUTH RIVER OPCO, LLC
Entity Type:Organization
Organization Name:BH BRIGHTVIEW SOUTH RIVER OPCO, LLC
Other - Org Name:BRIGHTVIEW SOUTH RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY BH BRIGHTVIEW
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLLENBERG
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-962-0595
Mailing Address - Street 1:8 LEE AIRPARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037
Mailing Address - Country:US
Mailing Address - Phone:410-956-7310
Mailing Address - Fax:410-956-7311
Practice Address - Street 1:8 LEE AIRPARK DRIVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037
Practice Address - Country:US
Practice Address - Phone:410-956-7310
Practice Address - Fax:410-956-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)