Healthcare Provider Details

I. General information

NPI: 1003325325
Provider Name (Legal Business Name): BRIGHTVIEW ANNAPOLIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 GENERALS HIGHWAY
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

1935 GENERALS HIGHWAY
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 443-808-1232
  • Fax: 443-499-8270
Mailing address:
  • Phone: 443-808-1232
  • Fax: 443-499-8270

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: BRIAN ENGLE
Title or Position: BRIGHTVIEW ANNAPOLIS, LLC AUTHORIZE
Credential:
Phone: 410-962-0595