Healthcare Provider Details

I. General information

NPI: 1396640330
Provider Name (Legal Business Name): BRIGHT HAVEN RESPITE AND SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAUREL WOOD WAY
FREDERICK MD
21701-2508
US

IV. Provider business mailing address

1515 LAUREL WOOD WAY
FREDERICK MD
21701-2508
US

V. Phone/Fax

Practice location:
  • Phone: 240-460-3735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SHEKERA MCLEOD
Title or Position: OWNER
Credential: RBT
Phone: 240-460-3735