Healthcare Provider Details

I. General information

NPI: 1467376004
Provider Name (Legal Business Name): BRIGHT RISING WELLNESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 UNION ST S STE 128
CONCORD NC
28025-5266
US

IV. Provider business mailing address

57 UNION ST S STE 128
CONCORD NC
28025-5266
US

V. Phone/Fax

Practice location:
  • Phone: 704-879-3000
  • Fax:
Mailing address:
  • Phone: 704-879-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: DAVERNA TALILLIAN PERRY
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 704-879-3000