1538726203 NPI number — BRIGHTSTONE, LLC

Table of content: (NPI 1538726203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538726203 NPI number — BRIGHTSTONE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTSTONE, 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:
SEEK WELLBEING HOUSECALLS PROGRAM
Provider Other Organization Name Type Code:
3
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:
1538726203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10040 PENTLAND HILLS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOW
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20136-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-497-8348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10040 PENTLAND HILLS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOW
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-888-4959
Provider Business Practice Location Address Fax Number:
703-995-0930
Provider Enumeration Date:
05/28/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GASKINS
Authorized Official First Name:
JOHANNA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
202-888-4959

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10145009 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com