Healthcare Provider Details

I. General information

NPI: 1194215046
Provider Name (Legal Business Name): BRIGHTVIEW SHELTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 01/09/2022
Certification Date: 01/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BEARD SAWMILL ROAD
SHELTON CT
06484
US

IV. Provider business mailing address

30 BEARD SAWMILL ROAD
SHELTON CT
06484
US

V. Phone/Fax

Practice location:
  • Phone: 203-493-4645
  • Fax: 203-538-7864
Mailing address:
  • Phone: 203-493-4345
  • Fax: 203-538-7864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: DOUG DOLLENBERG JR.
Title or Position: PRESIDENT
Credential:
Phone: 410-962-0595