Healthcare Provider Details

I. General information

NPI: 1467084459
Provider Name (Legal Business Name): BRIGHTER HORIZONS HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 VERONICA DR
MARTINSBURG WV
25404-3756
US

IV. Provider business mailing address

37 VERONICA DR
MARTINSBURG WV
25404-3756
US

V. Phone/Fax

Practice location:
  • Phone: 304-671-2582
  • Fax:
Mailing address:
  • Phone: 304-671-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CAMERON DUFFY
Title or Position: OWNER
Credential: MD
Phone: 304-671-2582