Healthcare Provider Details

I. General information

NPI: 1912775255
Provider Name (Legal Business Name): BRIGHT TRACK KIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 12/15/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 W BROOKS DR
BOISE ID
83714-9724
US

IV. Provider business mailing address

8081 W BROOKS DR
BOISE ID
83714-9724
US

V. Phone/Fax

Practice location:
  • Phone: 224-202-7067
  • Fax: 224-526-5164
Mailing address:
  • Phone: 224-202-7067
  • Fax: 224-526-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMY FRANCIS
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 224-202-7067