Healthcare Provider Details

I. General information

NPI: 1023289436
Provider Name (Legal Business Name): BRIGHT BEGINNINGS PDC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 WILLIAM LATHAM DR SUITE 6A
BOURBONNAIS IL
60914-2327
US

IV. Provider business mailing address

40 E JOLIET ST SUITE A
SCHERERVILLE IN
46375-2054
US

V. Phone/Fax

Practice location:
  • Phone: 815-932-0381
  • Fax: 815-932-0381
Mailing address:
  • Phone: 219-979-2735
  • Fax: 219-865-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number056-006344
License Number StateIL

VIII. Authorized Official

Name: MRS. AMANDA JOANNE KEMNETZ
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 815-932-0381