Healthcare Provider Details

I. General information

NPI: 1245036342
Provider Name (Legal Business Name): BRIGHT LIGHT CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9127 N BACKER AVE
FRESNO CA
93720-4113
US

IV. Provider business mailing address

2557 E GOSHEN AVE
FRESNO CA
93720-0503
US

V. Phone/Fax

Practice location:
  • Phone: 559-578-6624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ARLENE BAUTISTA
Title or Position: MANAGING PARTNER
Credential:
Phone: 559-578-6624