=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003116435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHTER FUTURE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2010
-----------------------------------------------------
Last Update Date | 11/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6239 EDGEWATER DRIVE BLDG V-1 SUITE 2
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-298-9264
-----------------------------------------------------
Fax | 407-298-9265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4946 ROSE AVENUE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-662-3554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. MARK G. FERGUSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-662-3554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 230332
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------