Provider Demographics
NPI:1548785215
Name:BRIGHTVIEW WAKEFIELD, LLC
Entity Type:Organization
Organization Name:BRIGHTVIEW WAKEFIELD, LLC
Other - Org Name:BRIGHTVIEW WAKEFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATOR FOR BRIGHTVIEW
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 1:21 CRESCENT STREET
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880
Mailing Address - Country:US
Mailing Address - Phone:781-486-4422
Mailing Address - Fax:
Practice Address - Street 1:21 CRESCENT STREET
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-667-0064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)