Provider Demographics
NPI:1962021329
Name:BRIGHTVIEW LLC
Entity Type:Organization
Organization Name:BRIGHTVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-544-1003
Mailing Address - Street 1:4600 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2697
Mailing Address - Country:US
Mailing Address - Phone:833-510-4357
Mailing Address - Fax:513-873-1567
Practice Address - Street 1:2202 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1281
Practice Address - Country:US
Practice Address - Phone:833-510-4357
Practice Address - Fax:866-460-2997
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTVIEW LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-15
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadoneGroup - Single Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY71006660760Medicaid