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General NPI Number Information
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NPI Number | 1104449503
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Entity Type | Organization
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Legal Business Name | BRIGHTLIFE INSTITUTE, LLC
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 2315 SHIMMERY LANE
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City | LAKE WORTH
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State | FL
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Zip | 33462
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Country | US
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Telephone | 305-901-3911
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 541173
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City | GREENACRES
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State | FL
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Zip | 33454-1173
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Country | US
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Telephone | 305-901-3911
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PRAD A GEORGES
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Credential |
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Telephone | 305-901-3911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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