Healthcare Provider Details

I. General information

NPI: 1831669928
Provider Name (Legal Business Name): BRIGHTIN ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 COMMONWEALTH AVE
BRIGHTON MA
02135-5428
US

IV. Provider business mailing address

1845 COMMONWEALTH AVE
BRIGHTON MA
02135-5428
US

V. Phone/Fax

Practice location:
  • Phone: 301-366-3844
  • Fax:
Mailing address:
  • Phone: 301-366-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GENNADY VINOKUR
Title or Position: MEMBER
Credential:
Phone: 301-366-3844