1376620518 NPI number — BRIGHTER DAY THERAPLAY LLC

Table of content: (NPI 1376620518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376620518 NPI number — BRIGHTER DAY THERAPLAY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTER DAY THERAPLAY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376620518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7209 E WT HARRIS BLVD STE J
Provider Second Line Business Mailing Address:
#134
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28227-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-452-0245
Provider Business Mailing Address Fax Number:
704-561-0850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7950 NATIONS FORD RD
Provider Second Line Business Practice Location Address:
SUITE B4
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28217-8014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-452-0245
Provider Business Practice Location Address Fax Number:
704-561-0850
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ISRA
Authorized Official First Name:
JAHZARA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CLINICAL SERVICES
Authorized Official Telephone Number:
704-248-1474

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  9759 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: 4329 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7212077 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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