MEDICARE: BRIGHT MOON GROUP HOME 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	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1841864543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT MOON GROUP HOME LLC

Provider Business Mailing Address
First Line	:	2600 NE 6TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-4375
Country	:	US
Telephone Number	:	239-245-4019
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 NE 6TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-4375
Country	:	US
Telephone Number	:	239-245-4019
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JEAN NICOLAS ORELUS
Credential	:	REGISTERED NURSE
Telephone Number	:	239-245-4019

Provider Enumeration Date	:	05/17/2021
Last Update Date	:	05/17/2021

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Directions to “BRIGHT MOON GROUP HOME LLC ” Practice Location

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