=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184430795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHT FUTURES CASE MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2024
-----------------------------------------------------
Last Update Date | 12/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 SCHOOL ST. BLDG B
-----------------------------------------------------
City | ELLENBORO WV
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 681-528-9127
-----------------------------------------------------
Fax | 304-869-3211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 93
-----------------------------------------------------
City | ELLENBORO
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26346-0093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 681-528-9127
-----------------------------------------------------
Fax | 304-869-3211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MERENA K CLINE-ELLIOTT
-----------------------------------------------------
Credential | LSW
-----------------------------------------------------
Telephone | 304-916-6977
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------