Healthcare Provider Details

I. General information

NPI: 1710881602
Provider Name (Legal Business Name): BRIGHT PATH HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 BEAVERS MILL RD APT A
DANVILLE VA
24540-1578
US

IV. Provider business mailing address

226 BEAVERS MILL RD APT A
DANVILLE VA
24540-1578
US

V. Phone/Fax

Practice location:
  • Phone: 434-713-5269
  • Fax:
Mailing address:
  • Phone: 434-713-5269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. KORI JEAN GUY
Title or Position: OWNER
Credential:
Phone: 434-713-5269