Healthcare Provider Details

I. General information

NPI: 1730957408
Provider Name (Legal Business Name): BRIGHTSIDE SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4888 STAMP RD
TEMPLE HILLS MD
20748-6715
US

IV. Provider business mailing address

4888 STAMP RD
TEMPLE HILLS MD
20748-6715
US

V. Phone/Fax

Practice location:
  • Phone: 410-625-7091
  • Fax:
Mailing address:
  • Phone: 410-625-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TAMEKA TAYLOR
Title or Position: FOUNDER/CEO
Credential:
Phone: 240-353-9809