Healthcare Provider Details

I. General information

NPI: 1629968037
Provider Name (Legal Business Name): BRIGHTON RESIDENTIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FOX CHASE RD
BLOOMFIELD CT
06002-2152
US

IV. Provider business mailing address

20 FOX CHASE RD
BLOOMFIELD CT
06002-2152
US

V. Phone/Fax

Practice location:
  • Phone: 860-890-3089
  • Fax:
Mailing address:
  • Phone: 860-890-3089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. AMOS JACK
Title or Position: DIRECTOR
Credential:
Phone: 860-305-6723