Healthcare Provider Details

I. General information

NPI: 1245680826
Provider Name (Legal Business Name): BRIGHTVIEW WARREN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MT. BETHEL ROAD
WARREN NJ
07059
US

IV. Provider business mailing address

55 MT. BETHEL ROAD
WARREN NJ
07059
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-3790
  • Fax: 908-412-6221
Mailing address:
  • Phone: 908-756-3790
  • Fax: 908-412-6221

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: MARILYNN K DUKER
Title or Position: PRESIDENT/AUTHORIZED SIGNATORY
Credential:
Phone: 410-962-0595