MEDICARE: BRIGHTSIDE LIVING GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1437980927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTSIDE LIVING GROUP LLC

Provider Business Mailing Address
First Line	:	7997 W SAHARA AVE STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7997 W SAHARA AVE STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7901
Country	:	US
Telephone Number	:	702-907-2887
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TYLER LUND
Credential	:
Telephone Number	:	801-505-3886

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/29/2024

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Directions to “BRIGHTSIDE LIVING GROUP LLC ” Practice Location

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