Healthcare Provider Details

I. General information

NPI: 1093255291
Provider Name (Legal Business Name): BRIGHTER HOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 BROOKS INDUSTRIAL RD
SHELBYVILLE KY
40065-8154
US

IV. Provider business mailing address

PO BOX 516
SHELBYVILLE KY
40066-0516
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1315
  • Fax: 502-633-1316
Mailing address:
  • Phone: 502-633-1315
  • Fax: 502-633-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number100328
License Number StateKY

VIII. Authorized Official

Name: KYLE STEPHENS
Title or Position: LLC MEMBER
Credential: LBA, BCBA
Phone: 502-633-1315