Healthcare Provider Details

I. General information

NPI: 1194585042
Provider Name (Legal Business Name): BRIGHT SPECTRUM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 FEDERAL DR STE 107
EAGAN MN
55122-1337
US

IV. Provider business mailing address

1375 DAVERN ST APT 119
SAINT PAUL MN
55116-2280
US

V. Phone/Fax

Practice location:
  • Phone: 651-497-8356
  • Fax:
Mailing address:
  • Phone: 651-497-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: FILMON L MICHAEL
Title or Position: OWNER
Credential:
Phone: 651-497-8356