MEDICARE: A BRIGHTER TOMORROW GROUP 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility		NC

General Provider Information

NPI Number	:	1831411156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BRIGHTER TOMORROW GROUP HOME

Provider Business Mailing Address
First Line	:	2214 ATLANTA ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-4002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2214 ATLANTA ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-4002
Country	:	US
Telephone Number	:	336-509-5559
Fax Number	:	336-378-9478

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. FREDERICK HAYES
Credential	:
Telephone Number	:	336-681-3072

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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