Healthcare Provider Details

I. General information

NPI: 1316480239
Provider Name (Legal Business Name): BRIGHT LIVES TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2016
Last Update Date: 11/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 PROFESSIONAL CT STE 9B
RALEIGH NC
27609-4913
US

IV. Provider business mailing address

4913 PROFESSIONAL CT STE 9B
RALEIGH NC
27609-4913
US

V. Phone/Fax

Practice location:
  • Phone: 252-367-2288
  • Fax:
Mailing address:
  • Phone: 252-367-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: EBONIE BROWN
Title or Position: PRESIDENT
Credential:
Phone: 919-916-8100