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General NPI Number Information
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NPI Number | 1073407698
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Entity Type | Organization
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Legal Business Name | BRIGHT LIFE ABA
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 02/26/2026
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Provider Practice Location Address
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Address Line | 110 E WAYNE ST FL 12
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City | FORT WAYNE
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State | IN
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Zip | 46802-2611
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Country | US
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Telephone | 845-304-5451
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Fax |
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Provider Business Mailing Address
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Address Line | 1718 NEW HAMPSHIRE AVE
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City | TOMS RIVER
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State | NJ
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Zip | 08755-2136
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Country | US
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Telephone | 845-304-5451
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHAYIM RUSS
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Credential |
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Telephone | 845-304-5451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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