Healthcare Provider Details

I. General information

NPI: 1962565077
Provider Name (Legal Business Name): BRIGHTWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 E STRATFORD AVE
SALT LAKE CITY UT
84106-3669
US

IV. Provider business mailing address

1603 E STRATFORD AVE
SALT LAKE CITY UT
84106-3669
US

V. Phone/Fax

Practice location:
  • Phone: 801-694-3205
  • Fax: 801-484-5968
Mailing address:
  • Phone: 801-694-3205
  • Fax: 801-484-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number11289
License Number StateUT

VIII. Authorized Official

Name: MR. CHRISTOPHER TODD JULIAN
Title or Position: PRESIDENT
Credential: MPA
Phone: 801-694-3205