Provider Demographics
NPI:1962850230
Name:BRIGHTVIEW BEL AIR
Entity Type:Organization
Organization Name:BRIGHTVIEW BEL AIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-893-2202
Mailing Address - Street 1:300 W RING FACTORY RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5387
Mailing Address - Country:US
Mailing Address - Phone:410-893-2202
Mailing Address - Fax:410-893-8137
Practice Address - Street 1:300 W RING FACTORY RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5387
Practice Address - Country:US
Practice Address - Phone:410-893-2202
Practice Address - Fax:410-893-8137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12AL0170-A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility