Healthcare Provider Details

I. General information

NPI: 1255015830
Provider Name (Legal Business Name): BRIGHTER OUTLOOK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8029 W MARION ST
MILWAUKEE WI
53222-1938
US

IV. Provider business mailing address

5219 W HOWARD AVE APT 1
MILWAUKEE WI
53220-2067
US

V. Phone/Fax

Practice location:
  • Phone: 262-720-0203
  • Fax:
Mailing address:
  • Phone: 414-915-3819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOMER D DEBERRY
Title or Position: CARE COORDINATOR/CO-OWNER
Credential:
Phone: 262-720-0203