Healthcare Provider Details

I. General information

NPI: 1598387979
Provider Name (Legal Business Name): A BRIGHTER VISION SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19620 NW 57TH PL
HIALEAH FL
33015-4923
US

IV. Provider business mailing address

19620 NW 57TH PL
HIALEAH FL
33015-4923
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-2763
  • Fax:
Mailing address:
  • Phone: 786-312-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEZERT DE BARA
Title or Position: CEO/ OWNER
Credential:
Phone: 786-312-2763