Healthcare Provider Details

I. General information

NPI: 1437841095
Provider Name (Legal Business Name): BRIGHTLIFE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BRYDEN RD # 122
COLUMBUS OH
43215-4839
US

IV. Provider business mailing address

700 BRYDEN RD # 122
COLUMBUS OH
43215-4839
US

V. Phone/Fax

Practice location:
  • Phone: 614-404-1337
  • Fax:
Mailing address:
  • Phone: 614-404-1337
  • 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: TARSICIO GACHERU
Title or Position: CNP
Credential: CNP
Phone: 614-404-1337