Healthcare Provider Details

I. General information

NPI: 1881810760
Provider Name (Legal Business Name): BRIGHTER PATH FAMILY CARE # 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7995 WAGMONT DR
BROWNS SUMMIT NC
27214-9024
US

IV. Provider business mailing address

7995 WAGMONT DR
BROWNS SUMMIT NC
27214-9024
US

V. Phone/Fax

Practice location:
  • Phone: 336-656-9208
  • Fax: 336-297-2191
Mailing address:
  • Phone: 336-656-9208
  • Fax: 336-297-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number322D00000X
License Number StateNC

VIII. Authorized Official

Name: MR. ALEXANDER MONROE NICHOLSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-656-9208