Healthcare Provider Details

I. General information

NPI: 1548785215
Provider Name (Legal Business Name): BRIGHTVIEW WAKEFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CRESCENT STREET
WAKEFIELD MA
01880
US

IV. Provider business mailing address

21 CRESCENT STREET
WAKEFIELD MA
01880
US

V. Phone/Fax

Practice location:
  • Phone: 781-667-0064
  • Fax:
Mailing address:
  • Phone: 781-486-4422
  • Fax:

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: DAVID GREYDANUS
Title or Position: AUTHORIZED SIGNATOR FOR BRIGHTVIEW
Credential:
Phone: 410-962-0595