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General NPI Number Information
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NPI Number | 1184503237
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Entity Type | Organization
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Legal Business Name | BRIGHT SHADOWS CORPORATION
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 01/03/2026
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Provider Practice Location Address
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Address Line | 687 US HIGHWAY 158 W
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City | GATES
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State | NC
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Zip | 27937-9807
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Country | US
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Telephone | 252-751-5103
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Fax | 252-751-5127
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Provider Business Mailing Address
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Address Line | PO BOX 9244
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City | HAMPTON
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State | VA
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Zip | 23670-0244
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Country | US
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Telephone | 252-751-5103
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Fax | 252-751-5127
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Authorized Official
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Title or Position | DIRECTOR
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Name | RONDESHYA KEYONNA COSBY
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Credential | PMHNP
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Telephone | 252-263-5787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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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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Taxonomy #8
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #11
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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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