Healthcare Provider Details

I. General information

NPI: 1073478335
Provider Name (Legal Business Name): BRIGHT FROM THE START
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 55TH ST
KENOSHA WI
53140-3731
US

IV. Provider business mailing address

625 55TH ST
KENOSHA WI
53140-3731
US

V. Phone/Fax

Practice location:
  • Phone: 262-748-8644
  • Fax: 262-748-8644
Mailing address:
  • Phone: 262-748-8644
  • Fax: 262-748-8644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: TIANA RAZAA
Title or Position: ADMINISTRATOR
Credential:
Phone: 262-748-8644