Healthcare Provider Details

I. General information

NPI: 1952014755
Provider Name (Legal Business Name): BRIGHTER CARE ADULT DAYCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 AVENUE A STE 100
FORT PIERCE FL
34950-4260
US

IV. Provider business mailing address

415 AVENUE A STE 100
FORT PIERCE FL
34950-4260
US

V. Phone/Fax

Practice location:
  • Phone: 772-828-3045
  • Fax: 772-302-3807
Mailing address:
  • Phone: 772-828-3045
  • Fax: 772-302-3807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANTELL WALKINE
Title or Position: OWN/MANAGER
Credential:
Phone: 772-828-3045