Provider Demographics
NPI:1093165672
Name:BRIGHTVIEW FAIRFAX, LLC
Entity Type:Organization
Organization Name:BRIGHTVIEW FAIRFAX, LLC
Other - Org Name:BRIGHTVIEW WOODBURN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREYDANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-962-0595
Mailing Address - Street 1:3450 GALLOWS ROAD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-462-9998
Mailing Address - Fax:703-992-7915
Practice Address - Street 1:3450 GALLOWS ROAD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-462-9998
Practice Address - Fax:703-992-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)