Healthcare Provider Details

I. General information

NPI: 1336958974
Provider Name (Legal Business Name): BRIGHT BEGINNINGS1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 BROADWAY
FORT WAYNE IN
46807-1509
US

IV. Provider business mailing address

811 E PONTIAC ST
FORT WAYNE IN
46803-3459
US

V. Phone/Fax

Practice location:
  • Phone: 260-704-5466
  • Fax:
Mailing address:
  • Phone: 260-704-5466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: KRONDA HUDDLESTON
Title or Position: OWNER
Credential:
Phone: 260-704-5466