=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184423832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHTLIGHT HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3330 MATLOCK RD # 201
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76015-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-248-3353
-----------------------------------------------------
Fax | 503-782-8301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 547 BRETON DR
-----------------------------------------------------
City | GRAND PRAIRIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75052-2525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-636-6532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ALTERNATE ADMINISTRATOR
-----------------------------------------------------
Name | GIDION K BUMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 682-248-3353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------