MEDICARE: BRIGHTWAY PERSONAL CARE HOME

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	310400000X	Assisted Living Facility		TX

General Provider Information

NPI Number	:	1538346788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTWAY PERSONAL CARE HOME

Provider Business Mailing Address
First Line	:	6730 WINDING TRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-1936
Country	:	US
Telephone Number	:	281-405-0117
Fax Number	:	281-397-7994

Provider Business Practice Location Address
First Line	:	6730 WINDING TRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-1936
Country	:	US
Telephone Number	:	281-405-0117
Fax Number	:	281-397-7994

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TONY UGBALA
Credential	:
Telephone Number	:	281-216-4073

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	01/29/2008

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Directions to “BRIGHTWAY PERSONAL CARE HOME ” Practice Location

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