Healthcare Provider Details

I. General information

NPI: 1780222091
Provider Name (Legal Business Name): BH BRIGHTVIEW NORTH ANDOVER OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 TURNPIKE STREET
NORTH ANDOVER MA
01845
US

IV. Provider business mailing address

1275 TURNPIKE STREET
NORTH ANDOVER MA
01845
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-2582
  • Fax: 978-686-2583
Mailing address:
  • Phone: 978-686-2582
  • Fax: 978-686-2583

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: BH BRIGHTVIEW NORTH ANDOVER OPCO
Credential:
Phone: 410-962-0595