Provider Demographics
NPI:1316596976
Name:BRIGHTVIEW CENTER, LLC
Entity type:Organization
Organization Name:BRIGHTVIEW CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANELLA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW-QS
Authorized Official - Phone:904-496-2962
Mailing Address - Street 1:731 DUVAL STATION ROAD
Mailing Address - Street 2:SUITE 107-231
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8331
Mailing Address - Country:US
Mailing Address - Phone:904-496-2962
Mailing Address - Fax:904-431-3554
Practice Address - Street 1:731 DUVAL STATION ROAD, SUITE 107-231
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8331
Practice Address - Country:US
Practice Address - Phone:904-496-2962
Practice Address - Fax:904-431-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102244700Medicaid