Healthcare Provider Details

I. General information

NPI: 1972067494
Provider Name (Legal Business Name): BRIGHTVIEW CROFTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CLARITY DRIVE
CROFTON MD
21114
US

IV. Provider business mailing address

1301 CLARITY DRIVE
CROFTON MD
21114
US

V. Phone/Fax

Practice location:
  • Phone: 443-494-6901
  • Fax: 443-494-6597
Mailing address:
  • Phone: 443-494-6901
  • Fax: 443-494-6597

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: BRIGHTVIEW CROFTON, LLC BY: DAVID G
Credential:
Phone: 410-962-0595