Healthcare Provider Details

I. General information

NPI: 1568101830
Provider Name (Legal Business Name): BH BRIGHTVIEW HOLDINGS INNOVATION CENTER TRS OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13700 MAGNA WAY
HERNDON VA
20171
US

IV. Provider business mailing address

13700 MAGNA WAY
HERNDON VA
20171
US

V. Phone/Fax

Practice location:
  • Phone: 571-786-5800
  • Fax: 571-786-5814
Mailing address:
  • Phone: 571-786-5800
  • Fax: 571-786-5814

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: BRIAN ENGLE
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 410-962-0595