Healthcare Provider Details

I. General information

NPI: 1053285619
Provider Name (Legal Business Name): BRIGHT FROM THE START HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
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: 262-605-2221
  • Fax:
Mailing address:
  • Phone: 262-605-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

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