Healthcare Provider Details

I. General information

NPI: 1467673335
Provider Name (Legal Business Name): BRIGHTSIDE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 RIVERDALE ST
W SPRINGFIELD MA
01089-1024
US

IV. Provider business mailing address

PO BOX 414484
BOSTON MA
02241-4484
US

V. Phone/Fax

Practice location:
  • Phone: 413-539-2973
  • Fax: 413-539-2454
Mailing address:
  • Phone: 413-539-2973
  • Fax: 413-539-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1474833
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1475734
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1475733
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1475735
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1475736
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1475732
License Number StateMA
# 7
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number5877
License Number StateMA

VIII. Authorized Official

Name: ROBERT L DEVEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 413-748-9308