Healthcare Provider Details

I. General information

NPI: 1316546575
Provider Name (Legal Business Name): BRIGHTERLIFE HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 INDIAN HEAD HWY STE 504
FT WASHINGTON MD
20744-4012
US

IV. Provider business mailing address

1904 ROBERT BOWIE DR
UPPER MARLBORO MD
20774-5667
US

V. Phone/Fax

Practice location:
  • Phone: 240-493-4704
  • Fax: 301-753-7003
Mailing address:
  • Phone: 240-467-0628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AHAOMA ROSE NNEBEDUM
Title or Position: PRESIDENT
Credential: PMHNP
Phone: 240-467-0628