Healthcare Provider Details

I. General information

NPI: 1023657400
Provider Name (Legal Business Name): BRIGHTVIEW BETHESDA GROSVENOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 GROSVENOR LANE
BETHESDA MD
20814
US

IV. Provider business mailing address

5510 GROSVENOR LANE
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 301-615-0119
  • Fax: 301-615-0605
Mailing address:
  • Phone: 301-615-0119
  • Fax: 301-615-0605

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 SIGNATORY
Credential:
Phone: 410-962-0595