Healthcare Provider Details

I. General information

NPI: 1104966399
Provider Name (Legal Business Name): SEA BRIGHT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 RACINE DR STE A2
WILMINGTON NC
28403-8850
US

IV. Provider business mailing address

219 RACINE DR STE A2
WILMINGTON NC
28403-8850
US

V. Phone/Fax

Practice location:
  • Phone: 910-342-9200
  • Fax: 910-342-0200
Mailing address:
  • Phone: 910-342-9200
  • Fax: 910-342-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3111
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA M KELLY
Title or Position: PRESIDENT
Credential:
Phone: 910-342-9200