Healthcare Provider Details

I. General information

NPI: 1174336150
Provider Name (Legal Business Name): BRIGHT LIFE ENHANCEMENT SERVICES,L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 03/22/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 EDMONDSON AVE STE 200
BALTIMORE MD
21229-1614
US

IV. Provider business mailing address

4200 EDMONDSON AVE STE 200
BALTIMORE MD
21229-1614
US

V. Phone/Fax

Practice location:
  • Phone: 410-988-2655
  • Fax: 410-988-2626
Mailing address:
  • Phone: 410-988-2655
  • Fax: 410-988-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ISLAMMIYYAH B AL-AMEEN
Title or Position: DIRECTOR OF PROGRAMS
Credential:
Phone: 410-988-2655