Healthcare Provider Details

I. General information

NPI: 1871131508
Provider Name (Legal Business Name): BH BRIGHTVIEW MOUNT LAUREL OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FERNBROOKE LANE
MT. LAUREL NJ
08054
US

IV. Provider business mailing address

400 FERNBROOKE LANE
MT. LAUREL NJ
08054
US

V. Phone/Fax

Practice location:
  • Phone: 856-222-1213
  • Fax: 856-802-9749
Mailing address:
  • Phone: 856-222-1213
  • Fax: 856-802-9749

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: DOUG DOLLENBERG JR.
Title or Position: AUTHORIZED SIGNATORY BH BRIGHTVIEW
Credential:
Phone: 410-962-0595