Healthcare Provider Details

I. General information

NPI: 1114875515
Provider Name (Legal Business Name): BRIGHT LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 SPECTRUM AVE SW
RIO RANCHO NM
87124-1888
US

IV. Provider business mailing address

153 SPECTRUM AVE SW
RIO RANCHO NM
87124-1888
US

V. Phone/Fax

Practice location:
  • Phone: 323-404-2379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ASMAMAW ANSHEBO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 323-404-2379