1235207333 NPI number — BRIGHTER DAY, INC

Table of content: (NPI 1235207333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235207333 NPI number — BRIGHTER DAY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTER DAY, INC
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:
1235207333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 CABIN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27406-8575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 GREEN VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27408-7728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-456-4275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHESNUTT
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
ROGERS
Authorized Official Title or Position:
MENTAL HEALTH COUNSELOR
Authorized Official Telephone Number:
336-456-4275

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  3603 , 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: 6005247 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6102358 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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