1215316807 NPI number — BRIGHT START EARLY INTERVENTION, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215316807 NPI number — BRIGHT START EARLY INTERVENTION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHT START EARLY INTERVENTION, 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:
1215316807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42419-0066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-860-9594
Provider Business Mailing Address Fax Number:
270-458-0022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 1/2 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42419-0066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-860-9594
Provider Business Practice Location Address Fax Number:
270-458-0022
Provider Enumeration Date:
05/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CONLEY
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
CAITLIN
Authorized Official Title or Position:
LISCENSED BEHAVIOR ANALYSIS IN KY
Authorized Official Telephone Number:
270-860-9594

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1004 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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