Healthcare Provider Details
I. General information
NPI: 1245661602
Provider Name (Legal Business Name): BRIGHTER TRANSITION YTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/10/2013
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
46560 264TH ST
SIOUX FALLS SD
57107-6903
US
IV. Provider business mailing address
46560 264TH ST
SIOUX FALLS SD
57107-6903
US
V. Phone/Fax
- Phone: 605-528-3550
- Fax:
- Phone: 605-528-3550
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 320800000X |
| Taxonomy | Mental Illness Community Based Residential Treatment Facility |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 323P00000X |
| Taxonomy | Psychiatric Residential Treatment Facility |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
JON
ST. PIERRE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 605-528-3550