Provider Demographics
NPI:1194215046
Name:BRIGHTVIEW SHELTON LLC
Entity Type:Organization
Organization Name:BRIGHTVIEW SHELTON LLC
Other - Org Name:BRIGHTVIEW SHELTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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 1:30 BEARD SAWMILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484
Mailing Address - Country:US
Mailing Address - Phone:203-493-4345
Mailing Address - Fax:203-538-7864
Practice Address - Street 1:30 BEARD SAWMILL ROAD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:203-493-4645
Practice Address - Fax:203-538-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)